Integrated cancer therapy—imaging apparatus and method of use thereof

ABSTRACT

The invention comprises a positively charged particle based cancer therapy system integrated with at least one off-axis imaging system, where elements of the off-axis imaging system and the cancer therapy system are co-positioned/co-rotated with a gantry. The imaging apparatus optionally functions with a tomography system using the positively charged particles of the cancer therapy system for enhanced patient/tumor imaging at and/or prior to a time of treatment.

CROSS-REFERENCES TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. patent applicationSer. No. 15/167,617 filed May 27, 2016, which is:

-   -   a continuation-in-part of U.S. patent application Ser. No.        15/152,479 filed May 11, 2016, which:        -   is a continuation-in-part of U.S. patent application Ser.            No. 14/216,788 filed Mar. 17, 2014,            -   which is a continuation-in-part of U.S. patent                application Ser. No. 13/087,096 filed Apr. 14, 2011,                which claims benefit of U.S. provisional patent                application No. 61/324,776 filed Apr. 16, 2010; and            -   is a continuation-in-part of U.S. patent application                Ser. No. 13/788,890 filed Mar. 7, 2013;        -   is a continuation-in-part of U.S. patent application Ser.            No. 14/952,817 filed Nov. 25, 2015, which is a            continuation-in-part of U.S. patent application Ser. No.            14/293,861 filed Jun. 2, 2014, which is a            continuation-in-part of U.S. patent application Ser. No.            12/985,039 filed Jan. 5, 2011, which claims the benefit of            U.S. provisional patent application No. 61/324,776, filed            Apr. 16, 2010;        -   is a continuation-in-part of U.S. patent application Ser.            No. 14/860,577 filed Sep. 21, 2015, which is a continuation            of U.S. patent application Ser. No. 14/223,289 filed Mar.            24, 2014, which is a continuation-in-part of U.S. patent            application Ser. No. 14/216,788 filed Mar. 17, 2014, which            is a continuation-in-part of U.S. patent application Ser.            No. 12/985,039 filed Jan. 5, 2011, which claims the benefit            of U.S. provisional patent application No. 61/324,776, filed            Apr. 16, 2010; and        -   is a continuation-in-part U.S. patent application Ser. No.            15/073,471 filed Mar. 17, 2016, which claims benefit of U.S.            provisional patent application No. 62/304,839 filed Mar. 7,            2016,    -   is a continuation-in-part of U.S. patent application Ser. No.        14/860,577 filed Sep. 21, 2015, which is a continuation of U.S.        patent application Ser. No. 14/223,289 filed Mar. 24, 2014,        which is a continuation-in-part of U.S. patent application Ser.        No. 14/216,788 filed Mar. 17, 2014, which is a        continuation-in-part of U.S. patent application Ser. No.        13/572,542 filed Aug. 10, 2012, which is a continuation-in-part        of U.S. patent application Ser. No. 12/425,683 filed Apr. 17,        2009, which claims the benefit of U.S. provisional patent        application No. 61/055,395 filed May 22, 2008, now U.S. Pat. No.        7,939,809 B2;    -   all of which are incorporated herein in their entirety by this        reference thereto.

BACKGROUND OF THE INVENTION

Field of the Invention

This invention relates generally to imaging and/or treatment of solidcancers. More particularly, the invention relates to control of acharged particle beam state using imaging in the cancer treatment roomwith the patient at least partially positioned for charged particletherapy.

Discussion of the Prior Art

Cancer Treatment

Proton therapy works by aiming energetic ionizing particles, such asprotons accelerated with a particle accelerator, onto a target tumor.These particles damage the DNA of cells, ultimately causing their death.Cancerous cells, because of their high rate of division and theirreduced ability to repair damaged DNA, are particularly vulnerable toattack on their DNA.

Patents related to the current invention are summarized here.

Proton Beam Therapy System

F. Cole, et. al. of Loma Linda University Medical Center “Multi-StationProton Beam Therapy System”, U.S. Pat. No. 4,870,287 (Sep. 26, 1989)describe a proton beam therapy system for selectively generating andtransporting proton beams from a single proton source and accelerator toa selected treatment room of a plurality of patient treatment rooms.

Imaging

P. Adamee, et. al. “Charged Particle Beam Apparatus and Method forOperating the Same”, U.S. Pat. No. 7,274,018 (Sep. 25, 2007) and P.Adamee, et. al. “Charged Particle Beam Apparatus and Method forOperating the Same”, U.S. Pat. No. 7,045,781 (May 16, 2006) describe acharged particle beam apparatus configured for serial and/or parallelimaging of an object.

K. Hiramoto, et. al. “Ion Beam Therapy System and its Couch PositioningSystem”, U.S. Pat. No. 7,193,227 (Mar. 20, 2007) describe an ion beamtherapy system having an X-ray imaging system moving in conjunction witha rotating gantry.

C. Maurer, et. al. “Apparatus and Method for Registration of Images toPhysical Space Using a Weighted Combination of Points and Surfaces”,U.S. Pat. No. 6,560,354 (May 6, 2003) described a process of X-raycomputed tomography registered to physical measurements taken on thepatient's body, where different body parts are given different weights.Weights are used in an iterative registration process to determine arigid body transformation process, where the transformation function isused to assist surgical or stereotactic procedures.

M. Blair, et. al. “Proton Beam Digital Imaging System”, U.S. Pat. No.5,825,845 (Oct. 20, 1998) describe a proton beam digital imaging systemhaving an X-ray source that is movable into a treatment beam line thatcan produce an X-ray beam through a region of the body. By comparison ofthe relative positions of the center of the beam in the patientorientation image and the isocentre in the master prescription imagewith respect to selected monuments, the amount and direction of movementof the patient to make the best beam center correspond to the targetisocentre is determined.

S. Nishihara, et. al. “Therapeutic Apparatus”, U.S. Pat. No. 5,039,867(Aug. 13, 1991) describe a method and apparatus for positioning atherapeutic beam in which a first distance is determined on the basis ofa first image, a second distance is determined on the basis of a secondimage, and the patient is moved to a therapy beam irradiation positionon the basis of the first and second distances.

Problem

There exists in the art of charged particle irradiation therapy a needto know and/or control position, direction, energy, intensity, and/orcross-sectional area or shape of the charged particle beam relative to atumor in a patient where a relative position of the tumor in the patientchanges with time.

SUMMARY OF THE INVENTION

The invention comprises a positively charged particle cancer treatmentmotion control system integrated with at least one imaging system.

DESCRIPTION OF THE FIGURES

A more complete understanding of the present invention is derived byreferring to the detailed description and claims when considered inconnection with the Figures, wherein like reference numbers refer tosimilar items throughout the Figures.

FIG. 1A and FIG. 1B illustrate component connections of a chargedparticle beam therapy system;

FIG. 2 illustrates a charged particle therapy system;

FIG. 3 illustrates a method of multi-axis charged particle beamirradiation control;

FIG. 4A and FIG. 4B illustrate a top view of a beam control tray and aside view of the beam control tray, respectively.

FIG. 5 illustrates patient specific tray inserts for insertion into thebeam control tray;

FIG. 6A illustrates insertion of the individualized tray assembly intothe beam path and FIG. 6B illustrates retraction of the tray assemblyinto a nozzle of the charged particle cancer therapy system;

FIG. 7 illustrates a tomography system;

FIG. 8 illustrates a beam path identification system;

FIG. 9A illustrates a beam path identification system coupled to a beamtransport system and a tomography scintillation detector and FIG. 9Billustrates the scintillation detector rotating with the patient andgantry nozzle;

FIG. 10 illustrates a treatment delivery control system;

FIG. 11 illustrates beam state determination systems;

FIG. 12A and FIG. 12B illustrate control of a patient interface systemwith a pendant and work-flow control system, respectively; and

FIG. 13A illustrates a two-dimensional—two-dimensional imaging systemrelative to a cancer treatment beam, FIG. 13B illustrates multiplegantry supported imaging systems, and FIG. 13C illustrates a rotatablecone beam.

Elements and steps in the figures are illustrated for simplicity andclarity and have not necessarily been rendered according to anyparticular sequence. For example, steps that are performed concurrentlyor in different order are illustrated in the figures to help improveunderstanding of embodiments of the present invention.

DETAILED DESCRIPTION OF THE INVENTION

The invention relates generally to at least one imaging system supportedand moved by a gantry system also used to direct a charged particlebeam, such as in treatment of a tumor of a patient.

In one embodiment, a gantry positions both: (1) a section of a beamtransport system, such as a terminal section, used to transport anddirect positively charged particles to a tumor and (2) at least oneimaging system. In one case, the imaging system is orientated on a sameaxis as the positively charged particle, such as at a different timethrough rotation of the gantry. In another case, the imaging system usesat least two crossing beamlines, each beamline coupled to a respectivedetector, to yield multiple views of the patient. In another case, oneor more imaging subsystem yields a two-dimensional image of the patient,such as for position confirmation and/or as part of a set of images usedto develop a three-dimensional image of the patient.

In another embodiment, multiple linked control stations are used tocontrol position of elements of a beam transport system, nozzle, and/orpatient specific beam shaping element relative to a dynamicallycontrolled patient position and/or an imaging surface, element, orsystem.

In another embodiment, a tomography system is optionally used incombination with a charged particle cancer therapy system. Optionallyand preferably, a common injector, accelerator, and beam transportsystem is used for both charged particle based tomographic imaging andcharged particle cancer therapy. In one case, an output nozzle of thebeam transport system is positioned with a gantry system while thegantry system and/or a patient support maintains a scintillation plateof the tomography system on the opposite side of the patient from theoutput nozzle.

In another example, a charged particle state determination system, of acancer therapy system or tomographic imaging system, uses one or morecoated layers in conjunction with a scintillation detector or atomographic imaging system at time of tumor and surrounding tissuesample mapping and/or at time of tumor treatment, such as to determinean input vector of the charged particle beam into a patient and/or anoutput vector of the charged particle beam from the patient.

In another example, the charged particle tomography apparatus is used incombination with a charged particle cancer therapy system. For example,tomographic imaging of a cancerous tumor is performed using chargedparticles generated with an injector, accelerator, and guided with adelivery system. The cancer therapy system uses the same injector,accelerator, and guided delivery system in delivering charged particlesto the cancerous tumor. For example, the tomography apparatus and cancertherapy system use a common raster beam method and apparatus fortreatment of solid cancers. More particularly, the invention comprises amulti-axis and/or multi-field raster beam charged particle acceleratorused in: (1) tomography and (2) cancer therapy. Optionally, the systemindependently controls patient translation position, patient rotationposition, two-dimensional beam trajectory, delivered radiation beamenergy, delivered radiation beam intensity, beam velocity, timing ofcharged particle delivery, and/or distribution of radiation strikinghealthy tissue. The system operates in conjunction with a negative ionbeam source, synchrotron, patient positioning, imaging, and/or targetingmethod and apparatus to deliver an effective and uniform dose ofradiation to a tumor while distributing radiation striking healthytissue.

In another embodiment, a treatment delivery control system (TDCS) ormain controller is used to control multiple aspects of the cancertherapy system, including one or more of: an imaging system, such as aCT or PET; a positioner, such as a couch or patient interface module; aninjector or injection system; a radio-frequency quadrupole system; aring accelerator or synchrotron; an extraction system; an irradiationplan; and a display system. The TDCS is preferably a control system forautomated cancer therapy once the patient is positioned. The TDCSintegrates output of one or more of the below described cancer therapysystem elements with inputs of one or more of the below described cancertherapy system elements. More generally, the TDCS controls or managesinput and/or output of imaging, an irradiation plan, and chargedparticle delivery.

In yet another embodiment, one or more trays are inserted into thepositively charged particle beam path, such as at or near the exit portof a gantry nozzle in close proximity to the patient. Each tray holds aninsert, such as a patient specific insert for controlling the energy,focus depth, and/or shape of the charged particle beam. Examples ofinserts include a range shifter, a compensator, an aperture, a ridgefilter, and a blank. Optionally and preferably, each tray communicates aheld and positioned insert to a main controller of the charged particlecancer therapy system. The trays optionally hold one or more of theimaging sheets configured to emit light upon transmission of the chargedparticle beam through a corresponding localized position of the one ormore imaging sheets.

Charged Particle Beam Therapy

Throughout this document, a charged particle beam therapy system, suchas a proton beam, hydrogen ion beam, or carbon ion beam, is described.Herein, the charged particle beam therapy system is described using aproton beam. However, the aspects taught and described in terms of aproton beam are not intended to be limiting to that of a proton beam andare illustrative of a charged particle beam system, a positively chargedbeam system, and/or a multiply charged particle beam system, such as C⁴⁺or C⁶⁺. Any of the techniques described herein are equally applicable toany charged particle beam system.

Referring now to FIG. 1A, a charged particle beam system 100 isillustrated. The charged particle beam preferably comprises a number ofsubsystems including any of: a main controller 110; an injection system120; a synchrotron 130 that typically includes: (1) an acceleratorsystem 132 and (2) an internal or connected extraction system 134; abeam transport system 135; a scanning/targeting/delivery system 140; apatient interface module 150; a display system 160; and/or an imagingsystem 170.

An exemplary method of use of the charged particle beam system 100 isprovided. The main controller 110 controls one or more of the subsystemsto accurately and precisely deliver protons to a tumor of a patient. Forexample, the main controller 110 obtains an image, such as a portion ofa body and/or of a tumor, from the imaging system 170. The maincontroller 110 also obtains position and/or timing information from thepatient interface module 150. The main controller 110 optionallycontrols the injection system 120 to inject a proton into a synchrotron130. The synchrotron typically contains at least an accelerator system132 and an extraction system 134. The main controller 110 preferablycontrols the proton beam within the accelerator system, such as bycontrolling speed, trajectory, and timing of the proton beam. The maincontroller then controls extraction of a proton beam from theaccelerator through the extraction system 134. For example, thecontroller controls timing, energy, and/or intensity of the extractedbeam. The controller 110 also preferably controls targeting of theproton beam through the scanning/targeting/delivery system 140 to thepatient interface module 150. One or more components of the patientinterface module 150, such as translational and rotational position ofthe patient, are preferably controlled by the main controller 110.Further, display elements of the display system 160 are preferablycontrolled via the main controller 110. Displays, such as displayscreens, are typically provided to one or more operators and/or to oneor more patients. In one embodiment, the main controller 110 times thedelivery of the proton beam from all systems, such that protons aredelivered in an optimal therapeutic manner to the tumor of the patient.

Herein, the main controller 110 refers to a single system controllingthe charged particle beam system 100, to a single controller controllinga plurality of subsystems controlling the charged particle beam system100, or to a plurality of individual controllers controlling one or moresub-systems of the charged particle beam system 100.

EXAMPLE I Charged Particle Cancer Therapy System Control

Referring now to FIG. 1B, an example of a charged particle cancertherapy system 100 is provided. A main controller receives input fromone, two, three, or four of a respiration monitoring and/or controllingcontroller 180, a beam controller 185, a rotation controller 147, and/ora timing to a time period in a respiration cycle controller 148. Thebeam controller 185 preferably includes one or more or a beam energycontroller 182, the beam intensity controller 340, a beam velocitycontroller 186, and/or a horizontal/vertical beam positioning controller188. The main controller 110 controls any element of the injectionsystem 120; the synchrotron 130; the scanning/targeting/delivery system140; the patient interface module 150; the display system 160; and/orthe imaging system 170. For example, the respirationmonitoring/controlling controller 180 controls any element or methodassociated with the respiration of the patient; the beam controller 185controls any of the elements controlling acceleration and/or extractionof the charged particle beam; the rotation controller 147 controls anyelement associated with rotation of the patient 830 or gantry; and thetiming to a period in respiration cycle controller 148 controls anyaspects affecting delivery time of the charged particle beam to thepatient. As a further example, the beam controller 185 optionallycontrols any magnetic and/or electric field about any magnet in thecharged particle cancer therapy system 100. One or more beam statesensors 190 sense position, direction, intensity, and/or energy of thecharged particles at one or more positions in the charged particle beampath. A tomography system 700, described infra, is optionally used tomonitor intensity and/or position of the charged particle beam.

Referring now to FIG. 2, an illustrative exemplary embodiment of oneversion of the charged particle beam system 100 is provided. The number,position, and described type of components is illustrative andnon-limiting in nature. In the illustrated embodiment, the injectionsystem 120 or ion source or charged particle beam source generatesprotons. The injection system 120 optionally includes one or more of: anegative ion beam source, an ion beam focusing lens, and a tandemaccelerator. The protons are delivered into a vacuum tube that runsinto, through, and out of the synchrotron. The generated protons aredelivered along an initial path 262. Focusing magnets 230, such asquadrupole magnets or injection quadrupole magnets, are used to focusthe proton beam path. A quadrupole magnet is a focusing magnet. Aninjector bending magnet 232 bends the proton beam toward a plane of thesynchrotron 130. The focused protons having an initial energy areintroduced into an injector magnet 240, which is preferably an injectionLamberson magnet. Typically, the initial beam path 262 is along an axisoff of, such as above, a circulating plane of the synchrotron 130. Theinjector bending magnet 232 and injector magnet 240 combine to move theprotons into the synchrotron 130. Main bending magnets, dipole magnets,turning magnets, or circulating magnets 250 are used to turn the protonsalong a circulating beam path 264. A dipole magnet is a bending magnet.The main bending magnets 250 bend the initial beam path 262 into acirculating beam path 264. In this example, the main bending magnets 250or circulating magnets are represented as four sets of four magnets tomaintain the circulating beam path 264 into a stable circulating beampath. However, any number of magnets or sets of magnets are optionallyused to move the protons around a single orbit in the circulationprocess. The protons pass through an accelerator 270. The acceleratoraccelerates the protons in the circulating beam path 264. As the protonsare accelerated, the fields applied by the magnets are increased.Particularly, the speed of the protons achieved by the accelerator 270are synchronized with magnetic fields of the main bending magnets 250 orcirculating magnets to maintain stable circulation of the protons abouta central point or region 280 of the synchrotron. At separate points intime the accelerator 270/main bending magnet 250 combination is used toaccelerate and/or decelerate the circulating protons while maintainingthe protons in the circulating path or orbit. An extraction element ofan inflector/deflector system is used in combination with a Lambersonextraction magnet 292 to remove protons from their circulating beam path264 within the synchrotron 130. One example of a deflector component isa Lamberson magnet. Typically the deflector moves the protons from thecirculating plane to an axis off of the circulating plane, such as abovethe circulating plane. Extracted protons are preferably directed and/orfocused using an extraction bending magnet 237 and extraction focusingmagnets 235, such as quadrupole magnets along a positively chargedparticle beam transport path 268 in a beam transport system 135, such asa beam path or proton beam path, into the scanning/targeting/deliverysystem 140. Two components of a scanning system 140 or targeting systemtypically include a first axis control 142, such as a vertical control,and a second axis control 144, such as a horizontal control. In oneembodiment, the first axis control 142 allows for about 100 mm ofvertical or y-axis scanning of the proton beam 268 and the second axiscontrol 144 allows for about 700 mm of horizontal or x-axis scanning ofthe proton beam 268. A nozzle system 146 is used for imaging the protonbeam, for defining shape of the proton beam, and/or as a vacuum barrierbetween the low pressure beam path of the synchrotron and theatmosphere. Protons are delivered with control to the patient interfacemodule 150 and to a tumor of a patient. All of the above listed elementsare optional and may be used in various permutations and combinations.

Proton Beam Extraction

Referring now to FIG. 3, both: (1) an exemplary proton beam extractionsystem 300 from the synchrotron 130 and (2) a charged particle beamintensity control system 305 are illustrated. For clarity, FIG. 3removes elements represented in FIG. 2, such as the turning magnets,which allows for greater clarity of presentation of the proton beam pathas a function of time. Generally, protons are extracted from thesynchrotron 130 by slowing the protons. As described, supra, the protonswere initially accelerated in a circulating path, which is maintainedwith a plurality of main bending magnets 250. The circulating path isreferred to herein as an original central beamline 264. The protonsrepeatedly cycle around a central point in the synchrotron 280. Theproton path traverses through a radio frequency (RF) cavity system 310.To initiate extraction, an RF field is applied across a first blade 312and a second blade 314, in the RF cavity system 310. The first blade 312and second blade 314 are referred to herein as a first pair of blades.

In the proton extraction process, an RF voltage is applied across thefirst pair of blades, where the first blade 312 of the first pair ofblades is on one side of the circulating proton beam path 264 and thesecond blade 314 of the first pair of blades is on an opposite side ofthe circulating proton beam path 264. The applied RF field appliesenergy to the circulating charged-particle beam. The applied RF fieldalters the orbiting or circulating beam path slightly of the protonsfrom the original central beamline 264 to an altered circulating beampath 265. Upon a second pass of the protons through the RF cavitysystem, the RF field further moves the protons off of the originalproton beamline 264. For example, if the original beamline is consideredas a circular path, then the altered beamline is slightly elliptical.The frequency of the applied RF field is timed to apply outward orinward movement to a given band of protons circulating in thesynchrotron accelerator. Orbits of the protons are slightly more offaxis compared to the original circulating beam path 264. Successivepasses of the protons through the RF cavity system are forced furtherand further from the original central beamline 264 by altering thedirection and/or intensity of the RF field with each successive pass ofthe proton beam through the RF field. Timing of application of the RFfield and/or frequency of the RF field is related to the circulatingcharged particles circulation pathlength in the synchrotron 130 and thevelocity of the charged particles so that the applied RF field has aperiod, with a peak-to-peak time period, equal to a period of time ofbeam circulation in the synchrotron 130 about the center 280 or aninteger multiple of the time period of beam circulation about the center280 of the synchrotron 130. Alternatively, the time period of beamcirculation about the center 280 of the synchrotron 130 is an integermultiple of the RF period time. The RF period is optionally used tocalculated the velocity of the charged particles, which relates directlyto the energy of the circulating charged particles.

The RF voltage is frequency modulated at a frequency about equal to theperiod of one proton cycling around the synchrotron for one revolutionor at a frequency than is an integral multiplier of the period of oneproton cycling about the synchrotron. The applied RF frequency modulatedvoltage excites a betatron oscillation. For example, the oscillation isa sine wave motion of the protons. The process of timing the RF field toa given proton beam within the RF cavity system is repeated thousands oftimes with each successive pass of the protons being moved approximatelyone micrometer further off of the original central beamline 264. Forclarity, the approximately 1000 changing beam paths with each successivepath of a given band of protons through the RF field are illustrated asthe altered beam path 265. The RF time period is process is known, thusenergy of the charged particles at time of hitting the extractionmaterial or material 330, described infra, is known.

With a sufficient sine wave betatron amplitude, the altered circulatingbeam path 265 touches and/or traverses a material 330, such as a foil ora sheet of foil. The foil is preferably a lightweight material, such asberyllium, a lithium hydride, a carbon sheet, or a material having lownuclear charge components. Herein, a material of low nuclear charge is amaterial composed of atoms consisting essentially of atoms having six orfewer protons. The foil is preferably about 10 to 150 microns thick, ismore preferably about 30 to 100 microns thick, and is still morepreferably about 40 to 60 microns thick. In one example, the foil isberyllium with a thickness of about 50 microns. When the protonstraverse through the foil, energy of the protons is lost and the speedof the protons is reduced. Typically, a current is also generated,described infra. Protons moving at the slower speed travel in thesynchrotron with a reduced radius of curvature 266 compared to eitherthe original central beamline 264 or the altered circulating path 265.The reduced radius of curvature 266 path is also referred to herein as apath having a smaller diameter of trajectory or a path having protonswith reduced energy. The reduced radius of curvature 266 is typicallyabout two millimeters less than a radius of curvature of the last passof the protons along the altered proton beam path 265.

The thickness of the material 330 is optionally adjusted to create achange in the radius of curvature, such as about ½, 1, 2, 3, or 4 mmless than the last pass of the protons 265 or original radius ofcurvature 264. The reduction in velocity of the charged particlestransmitting through the material 330 is calculable, such as by usingthe pathlength of the betatron oscillating charged particle beam throughthe material 330 and/or using the density of the material 330. Protonsmoving with the smaller radius of curvature travel between a second pairof blades. In one case, the second pair of blades is physically distinctand/or is separated from the first pair of blades. In a second case, oneof the first pair of blades is also a member of the second pair ofblades. For example, the second pair of blades is the second blade 314and a third blade 316 in the RF cavity system 310. A high voltage DCsignal, such as about 1 to 5 kV, is then applied across the second pairof blades, which directs the protons out of the synchrotron through anextraction magnet 292, such as a Lamberson extraction magnet, into atransport path 268.

Control of acceleration of the charged particle beam path in thesynchrotron with the accelerator and/or applied fields of the turningmagnets in combination with the above described extraction system allowsfor control of the intensity of the extracted proton beam, whereintensity is a proton flux per unit time or the number of protonsextracted as a function of time. For example, when a current is measuredbeyond a threshold, the RF field modulation in the RF cavity system isterminated or reinitiated to establish a subsequent cycle of proton beamextraction. This process is repeated to yield many cycles of proton beamextraction from the synchrotron accelerator.

In another embodiment, instead of moving the charged particles to thematerial 330, the material 330 is mechanically moved to the circulatingcharged particles. Particularly, the material 330 is mechanically orelectromechanically translated into the path of the circulating chargedparticles to induce the extraction process, described supra. In thiscase, the velocity or energy of the circulating charged particle beam iscalculable using the pathlength of the beam path about the center 280 ofthe synchrotron 130 and from the force applied by the bending magnets250.

In either case, because the extraction system does not depend on anychange in magnetic field properties, it allows the synchrotron tocontinue to operate in acceleration or deceleration mode during theextraction process. Stated differently, the extraction process does notinterfere with synchrotron acceleration. In stark contrast, traditionalextraction systems introduce a new magnetic field, such as via ahexapole, during the extraction process. More particularly, traditionalsynchrotrons have a magnet, such as a hexapole magnet, that is offduring an acceleration stage. During the extraction phase, the hexapolemagnetic field is introduced to the circulating path of the synchrotron.The introduction of the magnetic field necessitates two distinct modes,an acceleration mode and an extraction mode, which are mutuallyexclusive in time.

The herein described system allows for acceleration and/or decelerationof the proton during the extraction step and tumor treatment without theuse of a newly introduced magnetic field, such as by a hexapole magnet.

Charged Particle Beam Intensity Control

Control of applied field, such as a radio-frequency (RF) field,frequency and magnitude in the RF cavity system 310 allows for intensitycontrol of the extracted proton beam, where intensity is extractedproton flux per unit time or the number of protons extracted as afunction of time.

Still referring FIG. 3, the intensity control system 305 is furtherdescribed. In this example, an intensity control feedback loop is addedto the extraction system, described supra. When protons in the protonbeam hit the material 330 electrons are given off from the material 330resulting in a current. The resulting current is converted to a voltageand is used as part of an ion beam intensity monitoring system or aspart of an ion beam feedback loop for controlling beam intensity. Thevoltage is optionally measured and sent to the main controller 110 or toan intensity controller subsystem 340, which is preferably incommunication or under the direction of the main controller 110. Moreparticularly, when protons in the charged particle beam path passthrough the material 330, some of the protons lose a small fraction oftheir energy, such as about one-tenth of a percent, which results in asecondary electron. That is, protons in the charged particle beam pushsome electrons when passing through material 330 giving the electronsenough energy to cause secondary emission. The resulting electron flowresults in a current or signal that is proportional to the number ofprotons going through the target or extraction material 330. Theresulting current is preferably converted to voltage and amplified. Theresulting signal is referred to as a measured intensity signal.

The amplified signal or measured intensity signal resulting from theprotons passing through the material 330 is optionally used inmonitoring the intensity of the extracted protons and is preferably usedin controlling the intensity of the extracted protons. For example, themeasured intensity signal is compared to a goal signal, which ispredetermined in an irradiation of the tumor plan. The differencebetween the measured intensity signal and the planned for goal signal iscalculated. The difference is used as a control to the RF generator.Hence, the measured flow of current resulting from the protons passingthrough the material 330 is used as a control in the RF generator toincrease or decrease the number of protons undergoing betatronoscillation and striking the material 330. Hence, the voltage determinedoff of the material 330 is used as a measure of the orbital path and isused as a feedback control to control the RF cavity system.

In one example, the intensity controller subsystem 340 preferablyadditionally receives input from: (1) a detector 350, which provides areading of the actual intensity of the proton beam and/or (2) anirradiation plan 360. The irradiation plan provides the desiredintensity of the proton beam for each x, y, energy, and/or rotationalposition of the patient/tumor as a function of time. Thus, the intensitycontroller 340 receives the desired intensity from the irradiation plan350, the actual intensity from the detector 350 and/or a measure ofintensity from the material 330, and adjusts the amplitude and/or theduration of application of the applied radio-frequency field in the RFcavity system 310 to yield an intensity of the proton beam that matchesthe desired intensity from the irradiation plan 360.

As described, supra, the protons striking the material 330 is a step inthe extraction of the protons from the synchrotron 130. Hence, themeasured intensity signal is used to change the number of protons perunit time being extracted, which is referred to as intensity of theproton beam. The intensity of the proton beam is thus under algorithmcontrol. Further, the intensity of the proton beam is controlledseparately from the velocity of the protons in the synchrotron 130.Hence, intensity of the protons extracted and the energy of the protonsextracted are independently variable. Still further, the intensity ofthe extracted protons is controllably variable while scanning thecharged particles beam in the tumor from one voxel to an adjacent voxelas a separate hexapole and separated time period from accelerationand/or treatment is not required, as described supra.

For example, protons initially move at an equilibrium trajectory in thesynchrotron 130. An RF field is used to excite or move the protons intoa betatron oscillation. In one case, the frequency of the protons orbitis about 10 MHz. In one example, in about one millisecond or after about10,000 orbits, the first protons hit an outer edge of the targetmaterial 130. The specific frequency is dependent upon the period of theorbit. Upon hitting the material 130, the protons push electrons throughthe foil to produce a current. The current is converted to voltage andamplified to yield a measured intensity signal. The measured intensitysignal is used as a feedback input to control the applied RF magnitudeor RF field. An energy beam sensor, described infra, is optionally usedas a feedback control to the RF field frequency or RF field of the RFfield extraction system 310 to dynamically control, modify, and/or alterthe delivered charge particle beam energy, such as in a continuouspencil beam scanning system operating to treat tumor voxels withoutalternating between an extraction phase and a treatment phase.Preferably, the measured intensity signal is compared to a target signaland a measure of the difference between the measured intensity signaland target signal is used to adjust the applied RF field in the RFcavity system 310 in the extraction system to control the intensity ofthe protons in the extraction step. Stated again, the signal resultingfrom the protons striking and/or passing through the material 130 isused as an input in RF field modulation. An increase in the magnitude ofthe RF modulation results in protons hitting the foil or material 130sooner. By increasing the RF, more protons are pushed into the foil,which results in an increased intensity, or more protons per unit time,of protons extracted from the synchrotron 130.

In another example, a detector 350 external to the synchrotron 130 isused to determine the flux of protons extracted from the synchrotron anda signal from the external detector is used to alter the RF field, RFintensity, RF amplitude, and/or RF modulation in the RF cavity system310. Here the external detector generates an external signal, which isused in a manner similar to the measured intensity signal, described inthe preceding paragraphs. Preferably, an algorithm or irradiation plan360 is used as an input to the intensity controller 340, which controlsthe RF field modulation by directing the RF signal in the betatronoscillation generation in the RF cavity system 310. The irradiation plan360 preferably includes the desired intensity of the charged particlebeam as a function of time and/or energy of the charged particle beam asa function of time, for each patient rotation position, and/or for eachx-, y-position of the charged particle beam.

In yet another example, when a current from material 330 resulting fromprotons passing through or hitting material is measured beyond athreshold, the RF field modulation in the RF cavity system is terminatedor reinitiated to establish a subsequent cycle of proton beamextraction. This process is repeated to yield many cycles of proton beamextraction from the synchrotron accelerator.

In still yet another embodiment, intensity modulation of the extractedproton beam is controlled by the main controller 110. The maincontroller 110 optionally and/or additionally controls timing ofextraction of the charged particle beam and energy of the extractedproton beam.

The benefits of the system include a multi-dimensional scanning system.Particularly, the system allows independence in: (1) energy of theprotons extracted and (2) intensity of the protons extracted. That is,energy of the protons extracted is controlled by an energy controlsystem and an intensity control system controls the intensity of theextracted protons. The energy control system and intensity controlsystem are optionally independently controlled. Preferably, the maincontroller 110 controls the energy control system and the maincontroller 110 simultaneously controls the intensity control system toyield an extracted proton beam with controlled energy and controlledintensity where the controlled energy and controlled intensity areindependently variable and/or continually available as a separateextraction phase and acceleration phase are not required, as describedsupra. Thus the irradiation spot hitting the tumor is under independentcontrol of:

-   -   time;    -   energy;    -   intensity;    -   x-axis position, where the x-axis represents horizontal movement        of the proton beam relative to the patient, and    -   y-axis position, where the y-axis represents vertical movement        of the proton beam relative to the patient.

In addition, the patient is optionally independently translated and/orrotated relative to a translational axis of the proton beam at the sametime.

Beam Transport

The beam transport system 135 is used to move the charged particles fromthe accelerator to the patient, such as via a nozzle in a gantry,described infra.

Charged Particle Energy

The beam transport system 135 optionally includes means for determiningan energy of the charged particles in the charged particle beam. Forexample, an energy of the charged particle beam is determined viacalculation, such as via equation 1, using knowledge of a magnetgeometry and applied magnetic field to determine mass and/or energy.Referring now to equation 1, for a known magnet geometry, charge, q, andmagnetic field, B, the Larmor radius, ρ_(L), or magnet bend radius isdefined as:

$\begin{matrix}{\rho_{L} = {\frac{v_{\bot}}{\Omega_{c}} = \frac{\sqrt{2\;{Em}}}{qB}}} & ( {{eq}.\mspace{14mu} 1} )\end{matrix}$

where: ν_(⊥) is the ion velocity perpendicular to the magnetic field,Ω_(c) is the cyclotron frequency, q is the charge of the ion, B is themagnetic field, m is the mass of the charge particle, and E is thecharged particle energy. Solving for the charged particle energy yieldsequation 2.

$\begin{matrix}{E = \frac{( {\rho_{L}{qB}} )^{2}}{2\; m}} & ( {{eq}.\mspace{14mu} 2} )\end{matrix}$

Thus, an energy of the charged particle in the charged particle beam inthe beam transport system 135 is calculable from the know magnetgeometry, known or measured magnetic field, charged particle mass,charged particle charge, and the known magnet bend radius, which isproportional to and/or equivalent to the Larmor radius.

Nozzle

After extraction from the synchrotron 130 and transport of the chargedparticle beam along the proton beam path 268 in the beam transportsystem 135, the charged particle beam exits through the nozzle system146. In one example, the nozzle system includes a nozzle foil coveringan end of the nozzle system 146 or a cross-sectional area within thenozzle system forming a vacuum seal. The nozzle system includes a nozzlethat expands in x/y-cross-sectional area along the z-axis of the protonbeam path 268 to allow the proton beam 268 to be scanned along thex-axis and y-axis by the vertical control element and horizontal controlelement, respectively. The nozzle foil is preferably mechanicallysupported by the outer edges of an exit port of the nozzle 146. Anexample of a nozzle foil is a sheet of about 0.1 inch thick aluminumfoil. Generally, the nozzle foil separates atmosphere pressures on thepatient side of the nozzle foil from the low pressure region, such asabout 10⁻⁵ to 10⁻⁷ torr region, on the synchrotron 130 side of thenozzle foil. The low pressure region is maintained to reduce scatteringof the circulating charged particle beam in the synchrotron. Herein, theexit foil of the nozzle is optionally the first sheet 760 of the chargedparticle beam state determination system 750, described infra.

Charged Particle Control

Referring now to FIG. 4A, FIG. 4B, FIG. 5, FIG. 6A, and FIG. 6B, acharged particle beam control system is described where one or morepatient specific beam control assemblies are removably inserted into thecharged particle beam path proximate the nozzle of the charged particlecancer therapy system 100, where the patient specific beam controlassemblies adjust the beam energy, diameter, cross-sectional shape,focal point, and/or beam state of the charged particle beam to properlycouple energy of the charged particle beam to the individual's specifictumor.

Beam Control Tray

Referring now to FIG. 4A and FIG. 4B, a beam control tray assembly 400is illustrated in a top view and side view, respectively. The beamcontrol tray assembly 400 optionally comprises any of a tray frame 410,a tray aperture 412, a tray handle 420, a tray connector/communicator430, and means for holding a patient specific tray insert 510, describedinfra. Generally, the beam control tray assembly 400 is used to: (1)hold the patient specific tray insert 510 in a rigid location relativeto the beam control tray 400, (2) electronically identify the heldpatient specific tray insert 510 to the main controller 110, and (3)removably insert the patient specific tray insert 510 into an accurateand precise fixed location relative to the charged particle beam, suchas the proton beam path 268 at the nozzle of the charged particle cancertherapy system 100.

For clarity of presentation and without loss of generality, the meansfor holding the patient specific tray insert 510 in the tray frame 410of the beam control tray assembly 400 is illustrated as a set ofrecessed set screws 415. However, the means for holding the patientspecific tray insert 510 relative to the rest of the beam control trayassembly 400 is optionally any mechanical and/or electromechanicalpositioning element, such as a latch, clamp, fastener, clip, slide,strap, or the like. Generally, the means for holding the patientspecific tray insert 510 in the beam control tray 400 fixes the trayinsert and tray frame relative to one another even when rotated alongand/or around multiple axes, such as when attached to a charged particlecancer therapy system 100 dynamic gantry nozzle 610 or gantry nozzle,which is an optional element of the nozzle system 146, that moves inthree-dimensional space relative to a fixed point in the beamline,proton beam path 268, and/or a given patient position. As illustrated inFIG. 4A and FIG. 4B, the recessed set screws 415 fix the patientspecific tray insert 510 into the aperture 412 of the tray frame 410.The tray frame 410 is illustrated as circumferentially surrounding thepatient specific tray insert 510, which aids in structural stability ofthe beam control tray assembly 400. However, generally the tray frame410 is of any geometry that forms a stable beam control tray assembly400.

Still referring to FIG. 4A and now referring to FIG. 5 and FIG. 6A, theoptional tray handle 420 is used to manually insert/retract the beamcontrol tray assembly 400 into a receiving element of the gantry nozzleor dynamic gantry nozzle 610. While the beam control tray assembly 400is optionally inserted into the charged particle beam path 268 at anypoint after extraction from the synchrotron 130, the beam control trayassembly 400 is preferably inserted into the positively charged particlebeam proximate the dynamic gantry nozzle 610 as control of the beamshape is preferably done with little space for the beam shape to defocusbefore striking the tumor. Optionally, insertion and/or retraction ofthe beam control tray assembly 400 is semi-automated, such as in amanner of a digital-video disk player receiving a digital-video disk,with a selected auto load and/or a selected auto unload feature.

Patient Specific Tray Insert

Referring again to FIG. 5, a system of assembling trays 500 isdescribed. The beam control tray assembly 400 optionally and preferablyhas interchangeable patient specific tray inserts 510, such as a rangeshifter insert 511, a patient specific ridge filter insert 512, anaperture insert 513, a compensator insert 514, or a blank insert 515. Asdescribed, supra, any of the range shifter insert 511, the patientspecific ridge filter insert 512, the aperture insert 513, thecompensator insert 514, or the blank insert 515 after insertion into thetray frame 410 are inserted as the beam control tray assembly 400 intothe positively charged particle beam path 268, such as proximate thedynamic gantry nozzle 610.

Still referring to FIG. 5, the patient specific tray inserts 510 arefurther described. The patient specific tray inserts comprise acombination of any of: (1) a standardized beam control insert and (2) apatient specific beam control insert. For example, the range shifterinsert or 511 or compensator insert 514 used to control the depth ofpenetration of the charged particle beam into the patient is optionally:(a) a standard thickness of a beam slowing material, such as a firstthickness of Lucite, (b) one member of a set of members of varyingthicknesses and/or densities where each member of the set of membersslows the charged particles in the beam path by a known amount, or (c)is a material with a density and thickness designed to slow the chargedparticles by a customized amount for the individual patient beingtreated, based on the depth of the individual's tumor in the tissue, thethickness of intervening tissue, and/or the density of interveningbone/tissue. Similarly, the ridge filter insert 512 used to change thefocal point or shape of the beam as a function of depth is optionally:(1) selected from a set of ridge filters where different members of theset of ridge filters yield different focal depths or (2) customized fortreatment of the individual's tumor based on position of the tumor inthe tissue of the individual. Similarly, the aperture insert is: (1)optionally selected from a set of aperture shapes or (2) is a customizedindividual aperture insert 513 designed for the specific shape of theindividual's tumor. The blank insert 515 is an open slot, but serves thepurpose of identifying slot occupancy, as described infra.

Slot Occupancy/Identification

Referring again to FIG. 4A, FIG. 4B, and FIG. 5, occupancy andidentification of the particular patient specific tray insert 510 intothe beam control tray assembly 400 is described. Generally, the beamcontrol tray assembly 400 optionally contains means for identifying, tothe main controller 110 and/or a treatment delivery control systemdescribed infra, the specific patient tray insert 510 and its locationin the charged particle beam path 268. First, the particular tray insertis optionally labeled and/or communicated to the beam control trayassembly 400 or directly to the main controller 110. Second, the beamcontrol tray assembly 400 optionally communicates the tray type and/ortray insert to the main controller 110. In various embodiments,communication of the particular tray insert to the main controller 110is performed: (1) directly from the tray insert, (2) from the trayinsert 510 to the tray assembly 400 and subsequently to the maincontroller 110, and/or (3) directly from the tray assembly 400.Generally, communication is performed wirelessly and/or via anestablished electromechanical link. Identification is optionallyperformed using a radio-frequency identification label, use of abarcode, or the like, and/or via operator input. Examples are providedto further clarify identification of the patient specific tray insert510 in a given beam control tray assembly 400 to the main controller.

In a first example, one or more of the patient specific tray inserts510, such as the range shifter insert 511, the patient specific ridgefilter insert 512, the aperture insert 513, the compensator insert 514,or the blank insert 515 include an identifier 520 and/or and a firstelectromechanical identifier plug 530. The identifier 520 is optionallya label, a radio-frequency identification tag, a barcode, a2-dimensional bar-code, a matrix-code, or the like. The firstelectromechanical identifier plug 530 optionally includes memoryprogrammed with the particular patient specific tray insert informationand a connector used to communicate the information to the beam controltray assembly 400 and/or to the main controller 110. As illustrated inFIG. 5, the first electromechanical identifier plug 530 affixed to thepatient specific tray insert 510 plugs into a second electromechanicalidentifier plug, such as the tray connector/communicator 430, of thebeam control tray assembly 400, which is described infra.

In a second example, the beam control tray assembly 400 uses the secondelectromechanical identifier plug to send occupancy, position, and/oridentification information related to the type of tray insert or thepatient specific tray insert 510 associated with the beam control trayassembly to the main controller 110. For example, a first tray assemblyis configured with a first tray insert and a second tray assembly isconfigured with a second tray insert. The first tray assembly sendsinformation to the main controller 110 that the first tray assemblyholds the first tray insert, such as a range shifter, and the secondtray assembly sends information to the main controller 110 that thesecond tray assembly holds the second tray insert, such as an aperture.The second electromechanical identifier plug optionally containsprogrammable memory for the operator to input the specific tray inserttype, a selection switch for the operator to select the tray inserttype, and/or an electromechanical connection to the main controller. Thesecond electromechanical identifier plug associated with the beamcontrol tray assembly 400 is optionally used without use of the firstelectromechanical identifier plug 530 associated with the tray insert510.

In a third example, one type of tray connector/communicator 430 is usedfor each type of patient specific tray insert 510. For example, a firstconnector/communicator type is used for holding a range shifter insert511, while a second, third, fourth, and fifth connector/communicatortype is used for trays respectively holding a patient specific ridgefilter insert 512, an aperture insert 513, a compensator insert 514, ora blank insert 515. In one case, the tray communicates tray type withthe main controller. In a second case, the tray communicates patientspecific tray insert information with the main controller, such as anaperture identifier custom built for the individual patient beingtreated.

Tray Insertion/Coupling

Referring now to FIG. 6A and FIG. 6B a beam control insertion process600 is described. The beam control insertion process 600 comprises: (1)insertion of the beam control tray assembly 400 and the associatedpatient specific tray insert 510 into the charged particle beam path 268and/or dynamic gantry nozzle 610, such as into a tray assembly receiver620 and (2) an optional partial or total retraction of beam of the trayassembly receiver 620 into the dynamic gantry nozzle 610.

Referring now to FIG. 6A, insertion of one or more of the beam controltray assemblies 400 and the associated patient specific tray inserts 510into the dynamic gantry nozzle 610 is further described. In FIG. 6A,three beam control tray assemblies, of a possible n tray assemblies, areillustrated, a first tray assembly 402, a second tray assembly 404, anda third tray assembly 406, where n is a positive integer of 1, 2, 3, 4,5 or more. As illustrated, the first tray assembly 402 slides into afirst receiving slot 403, the second tray assembly 404 slides into asecond receiving slot 405, and the third tray assembly 406 slides into athird receiving slot 407. Generally, any tray optionally inserts intoany slot or tray types are limited to particular slots through use of amechanical, physical, positional, and/or steric constraints, such as afirst tray type configured for a first insert type having a first sizeand a second tray type configured for a second insert type having asecond distinct size at least ten percent different from the first size.

Still referring to FIG. 6A, identification of individual tray insertsinserted into individual receiving slots is further described. Asillustrated, sliding the first tray assembly 402 into the firstreceiving slot 403 connects the associated electromechanicalconnector/communicator 430 of the first tray assembly 402 to a firstreceptor 626. The electromechanical connector/communicator 430 of thefirst tray assembly communicates tray insert information of the firstbeam control tray assembly to the main controller 110 via the firstreceptor 626. Similarly, sliding the second tray assembly 404 into thesecond receiving slot 405 connects the associated electromechanicalconnector/communicator 430 of the second tray assembly 404 into a secondreceptor 627, which links communication of the associatedelectromechanical connector/communicator 430 with the main controller110 via the second receptor 627, while a third receptor 628 connects tothe electromechanical connected placed into the third slot 407. Thenon-wireless/direct connection is preferred due to the high radiationlevels within the treatment room and the high shielding of the treatmentroom, which both hinder wireless communication. The connection of thecommunicator and the receptor is optionally of any configuration and/ororientation.

Tray Receiver Assembly Retraction

Referring again to FIG. 6A and FIG. 6B, retraction of the tray receiverassembly 620 relative to a nozzle end 612 of the dynamic gantry nozzle610 is described. The tray receiver assembly 620 comprises a frameworkto hold one or more of the beam control tray assemblies 400 in one ormore slots, such as through use of a first tray receiver assembly side622 through which the beam control tray assemblies 400 are insertedand/or through use of a second tray receiver assembly side 624 used as abackstop, as illustrated holding the plugin receptors configured toreceive associated tray connector/communicators 430, such as the first,second, and third receptors 626, 627, 628. Optionally, the tray receiverassembly 620 retracts partially or completely into the dynamic gantrynozzle 610 using a retraction mechanism 660 configured to alternatinglyretract and extend the tray receiver assembly 620 relative to a nozzleend 612 of the gantry nozzle 610, such as along a first retraction track662 and a second retraction track 664 using one or more motors andcomputer control. Optionally the tray receiver assembly 620 is partiallyor fully retracted when moving the gantry, nozzle, and/or gantry nozzle610 to avoid physical constraints of movement, such as potentialcollision with another object in the patient treatment room.

For clarity of presentation and without loss of generality, severalexamples of loading patient specific tray inserts into tray assemblieswith subsequent insertion into an positively charged particle beam pathproximate a gantry nozzle 610 are provided.

In a first example, a single beam control tray assembly 400 is used tocontrol the charged particle beam 268 in the charged particle cancertherapy system 100. In this example, a patient specific range shifterinsert 511, which is custom fabricated for a patient, is loaded into apatient specific tray insert 510 to form a first tray assembly 402,where the first tray assembly 402 is loaded into the third receptor 628,which is fully retracted into the gantry nozzle 610.

In a second example, two beam control assemblies 400 are used to controlthe charged particle beam 268 in the charged particle cancer therapysystem 100. In this example, a patient specific ridge filter 512 isloaded into a first tray assembly 402, which is loaded into the secondreceptor 627 and a patient specific aperture 513 is loaded into a secondtray assembly 404, which is loaded into the first receptor 626 and thetwo associated tray connector/communicators 430 using the first receptor626 and second receptor 627 communicate to the main controller 110 thepatient specific tray inserts 510. The tray receiver assembly 620 issubsequently retracted one slot so that the patient specific ridgefilter 512 and the patient specific aperture reside outside of and atthe nozzle end 612 of the gantry nozzle 610.

In a third example, three beam control tray assemblies 400 are used,such as a range shifter 511 in a first tray inserted into the firstreceiving slot 403, a compensator in a second tray inserted into thesecond receiving slot 405, and an aperture in a third tray inserted intothe third receiving slot 407.

Generally, any patient specific tray insert 510 is inserted into a trayframe 410 to form a beam control tray assembly 400 inserted into anyslot of the tray receiver assembly 620 and the tray assembly is notretracted or retracted any distance into the gantry nozzle 610.

Tomography/Beam State

In one embodiment, the charged particle tomography apparatus is used toimage a tumor in a patient. As current beam positiondetermination/verification is used in both tomography and cancer therapytreatment, for clarity of presentation and without limitation beam statedetermination is also addressed in this section. However, beam statedetermination is optionally used separately and without tomography.

In another example, the charged particle tomography apparatus is used incombination with a charged particle cancer therapy system using commonelements. For example, tomographic imaging of a cancerous tumor isperformed using charged particles generated with an injector,accelerator, and guided with a delivery system that are part of thecancer therapy system, described supra.

In various examples, the tomography imaging system is optionallysimultaneously operational with a charged particle cancer therapy systemusing common elements, allows tomographic imaging with rotation of thepatient, is operational on a patient in an upright, semi-upright, and/orhorizontal position, is simultaneously operational with X-ray imaging,and/or allows use of adaptive charged particle cancer therapy. Further,the common tomography and cancer therapy apparatus elements areoptionally operational in a multi-axis and/or multi-field raster beammode.

In conventional medical X-ray tomography, a sectional image through abody is made by moving one or both of an X-ray source and the X-ray filmin opposite directions during the exposure. By modifying the directionand extent of the movement, operators can select different focal planes,which contain the structures of interest. More modern variations oftomography involve gathering projection data from multiple directions bymoving the X-ray source and feeding the data into a tomographicreconstruction software algorithm processed by a computer. Herein, instark contrast to known methods, the radiation source is a chargedparticle, such as a proton ion beam or a carbon ion beam. A proton beamis used herein to describe the tomography system, but the descriptionapplies to a heavier ion beam, such as a carbon ion beam. Further, instark contrast to known techniques, herein the radiation source ispreferably stationary while the patient is rotated.

Referring now to FIG. 7, an example of a tomography apparatus isdescribed and an example of a beam state determination is described. Inthis example, the tomography system 700 uses elements in common with thecharged particle beam system 100, including elements of one or more ofthe injection system 120, accelerator 130, targeting/delivery system140, patient interface module 150, display system 160, and/or imagingsystem 170, such as the X-ray imaging system. One or more scintillationplates, such as a scintillating plastic, are used to measure energy,intensity, and/or position of the charged particle beam. For instance, ascintillation plate 710 is positioned behind the patient 730 relative tothe targeting/delivery system 140 elements, which is optionally used tomeasure intensity and/or position of the charged particle beam aftertransmitting through the patient. Optionally, a second scintillationplate or a charged particle induced photon emitting sheet, describedinfra, is positioned prior to the patient 730 relative to thetargeting/delivery system 140 elements, which is optionally used tomeasure incident intensity and/or position of the charged particle beamprior to transmitting through the patient. The charged particle beamsystem 100 as described has proven operation at up to and including 330MeV, which is sufficient to send protons through the body and intocontact with the scintillation material. Particularly, 250 MeV to 330MeV are used to pass the beam through a standard sized patient with astandard sized pathlength, such as through the chest. The intensity orcount of protons hitting the plate as a function of position is used tocreate an image. The velocity or energy of the proton hitting thescintillation plate is also used in creation of an image of the tumor720 and/or an image of the patient 730. The patient 730 is rotated aboutthe y-axis and a new image is collected. Preferably, a new image iscollected with about every one degree of rotation of the patientresulting in about 360 images that are combined into a tomogram usingtomographic reconstruction software. The tomographic reconstructionsoftware uses overlapping rotationally varied images in thereconstruction. Optionally, a new image is collected at about every 2,3, 4, 5, 10, 15, 30, or 45 degrees of rotation of the patient.

In one embodiment, a tomogram or an individual tomogram section image iscollected at about the same time as cancer therapy occurs using thecharged particle beam system 100. For example, a tomogram is collectedand cancer therapy is subsequently performed: without the patient movingfrom the positioning systems, such as in a semi-vertical partialimmobilization system, a sitting partial immobilization system, or the alaying position. In a second example, an individual tomogram slice iscollected using a first cycle of the accelerator 130 and using afollowing cycle of the accelerator 130, the tumor 720 is irradiated,such as within about 1, 2, 5, 10, 15 or 30 seconds. In a third case,about 2, 3, 4, or 5 tomogram slices are collected using 1, 2, 3, 4, ormore rotation positions of the patient 730 within about 5, 10, 15, 30,or 60 seconds of subsequent tumor irradiation therapy.

In another embodiment, the independent control of the tomographicimaging process and X-ray collection process allows simultaneous singleand/or multi-field collection of X-ray images and tomographic imageseasing interpretation of multiple images. Indeed, the X-ray andtomographic images are optionally overlaid to from a hybrid X-ray/protonbeam tomographic image as the patient 730 is optionally in the sameposition for each image.

In still another embodiment, the tomogram is collected with the patient730 in the about the same position as when the patient's tumor istreated using subsequent irradiation therapy. For some tumors, thepatient being positioned in the same upright or semi-upright positionallows the tumor 720 to be separated from surrounding organs or tissueof the patient 730 better than in a laying position.

Positioning of the scintillation plate 710 behind the patient 730 allowsthe tomographic imaging to occur while the patient is in the sameupright or semi-upright position.

The use of common elements in the tomographic imaging and in the chargedparticle cancer therapy allows benefits of the cancer therapy, describedsupra, to optionally be used with the tomographic imaging, such asproton beam x-axis control, proton beam y-axis control, control ofproton beam energy, control of proton beam intensity, timing control ofbeam delivery to the patient, rotation control of the patient, andcontrol of patient translation all in a raster beam mode of protonenergy delivery. The use of a single proton or cation beamline for bothimaging and treatment facilitates eases patient setup, reduces alignmentuncertainties, reduces beam state uncertainties, and eases qualityassurance.

In yet still another embodiment, initially a three-dimensionaltomographic proton based reference image is collected, such as withhundreds of individual rotation images of the tumor 720 and patient 730.Subsequently, just prior to proton treatment of the cancer, just a few2-dimensional control tomographic images of the patient are collected,such as with a stationary patient or at just a few rotation positions,such as an image straight on to the patient, with the patient rotatedabout 45 degrees each way, and/or the patient rotated about 90 degreeseach way about the y-axis. The individual control images are comparedwith the 3-dimensional reference image. An adaptive proton therapy issubsequently performed where: (1) the proton cancer therapy is not usedfor a given position based on the differences between the 3-dimensionalreference image and one or more of the 2-dimensional control imagesand/or (2) the proton cancer therapy is modified in real time based onthe differences between the 3-dimensional reference image and one ormore of the 2-dimensional control images.

Charged Particle State Determination/Verification/Photonic Monitoring

Still referring to FIG. 7, the tomography system 700 is optionally usedwith a charged particle beam state determination system 750, optionallyused as a charged particle verification system. The charged particlestate determination system 750 optionally measures, determines, and/orverifies one of more of: (1) position of the charged particle beam, (2)direction of the charged particle beam, (3) intensity of the chargedparticle beam, (4) energy of the charged particle beam, and (5) ahistory of the charged particle beam.

For clarity of presentation and without loss of generality, adescription of the charged particle beam state determination system 750is described and illustrated separately in FIG. 8 and FIG. 9A; however,as described herein elements of the charged particle beam statedetermination system 750 are optionally and preferably integrated intothe nozzle system 146 and/or the tomography system 700 of the chargedparticle treatment system 100. More particularly, any element of thecharged particle beam state determination system 750 is integrated intothe nozzle system 146, the dynamic gantry nozzle 610, and/or tomographysystem 700, such as a surface of the scintillation plate 710 or asurface of a scintillation detector, plate, or system. The nozzle system146 or the dynamic gantry nozzle 610 provides an outlet of the chargedparticle beam from the vacuum tube initiating at the injection system120 and passing through the synchrotron 130 and beam transport system135. Any plate, sheet, fluorophore, or detector of the charged particlebeam state determination system is optionally integrated into the nozzlesystem 146. For example, an exit foil of the nozzle 610 is optionally afirst sheet 760 of the charged particle beam state determination system750 and a first coating 762 is optionally coated onto the exit foil, asillustrated in FIG. 7. Similarly, optionally a surface of thescintillation plate 710 is a support surface for a fourth coating 792,as illustrated in FIG. 7. The charged particle beam state determinationsystem 750 is further described, infra.

Referring now to FIG. 7, FIG. 8, and FIG. 9A, four sheets, a first sheet760, a second sheet 770, a third sheet 780, and a fourth sheet 790 areused to illustrated detection sheets and/or photon emitting sheets upontransmittance of a charged particle beam. Each sheet is optionallycoated with a photon emitter, such as a fluorophore, such as the firstsheet 760 is optionally coated with a first coating 762. Without loss ofgenerality and for clarity of presentation, the four sheets are eachillustrated as units, where the light emitting layer is not illustrated.Thus, for example, the second sheet 770 optionally refers to a supportsheet, a light emitting sheet, and/or a support sheet coated by a lightemitting element. The four sheets are representative of n sheets, wheren is a positive integer.

Referring now to FIG. 7 and FIG. 8, the charged particle beam stateverification system 750 is a system that allows for monitoring of theactual charged particle beam position in real-time without destructionof the charged particle beam. The charged particle beam stateverification system 750 preferably includes a first position element orfirst beam verification layer, which is also referred to herein as acoating, luminescent, fluorescent, phosphorescent, radiance, or viewinglayer. The first position element optionally and preferably includes acoating or thin layer substantially in contact with a sheet, such as aninside surface of the nozzle foil, where the inside surface is on thesynchrotron side of the nozzle foil. Less preferably, the verificationlayer or coating layer is substantially in contact with an outer surfaceof the nozzle foil, where the outer surface is on the patient treatmentside of the nozzle foil. Preferably, the nozzle foil provides asubstrate surface for coating by the coating layer. Optionally, abinding layer is located between the coating layer and the nozzle foil,substrate, or support sheet. Optionally, the position element is placedanywhere in the charged particle beam path. Optionally, more than oneposition element on more than one sheet, respectively, is used in thecharged particle beam path and is used to determine a state property ofthe charged particle beam, as described infra.

Still referring to FIG. 7 and FIG. 8, the coating, referred to as afluorophore, yields a measurable spectroscopic response, spatiallyviewable by a detector or camera, as a result of transmission by theproton beam. The coating is preferably a phosphor, but is optionally anymaterial that is viewable or imaged by a detector where the materialchanges spectroscopically as a result of the charged particle beamhitting or transmitting through the coating or coating layer. A detectoror camera views secondary photons emitted from the coating layer anddetermines a position of a treatment beam 269, which is also referred toas a current position of the charged particle beam or final treatmentvector of the charged particle beam, by the spectroscopic differencesresulting from protons and/or charged particle beam passing through thecoating layer. For example, the camera views a surface of the coatingsurface as the proton beam or positively charged cation beam is beingscanned by the first axis control 142, vertical control, and the secondaxis control 144, horizontal control, beam position control elementsduring treatment of the tumor 720. The camera views the current positionof the charged particle beam or treatment beam 269 as measured byspectroscopic response. The coating layer is preferably a phosphor orluminescent material that glows and/or emits photons for a short periodof time, such as less than 5 seconds for a 50% intensity, as a result ofexcitation by the charged particle beam. The detector observes thetemperature change and/or observe photons emitted from the chargedparticle beam traversed spot. Optionally, a plurality of cameras ordetectors are used, where each detector views all or a portion of thecoating layer. For example, two detectors are used where a firstdetector views a first half of the coating layer and the second detectorviews a second half of the coating layer. Preferably, at least a portionof the detector is mounted into the nozzle system to view the protonbeam position after passing through the first axis and second axiscontrollers 142, 144. Preferably, the coating layer is positioned in theproton beam path 268 in a position prior to the protons striking thepatient 730.

Referring now to FIG. 1 and FIG. 7, the main controller 110, connectedto the camera or detector output, optionally and preferably compares thefinal proton beam position or position of the treatment beam 269 withthe planned proton beam position and/or a calibration reference todetermine if the actual proton beam position or position of thetreatment beam 269 is within tolerance. The charged particle beam statedetermination system 750 preferably is used in one or more phases, suchas a calibration phase, a mapping phase, a beam position verificationphase, a treatment phase, and a treatment plan modification phase. Thecalibration phase is used to correlate, as a function of x-, y-positionof the glowing response the actual x-, y-position of the proton beam atthe patient interface. During the treatment phase, the charged particlebeam position is monitored and compared to the calibration and/ortreatment plan to verify accurate proton delivery to the tumor 720and/or as a charged particle beam shutoff safety indicator. Referringnow to FIG. 10, the position verification system 172 and/or thetreatment delivery control system 112, upon determination of a tumorshift, an unpredicted tumor distortion upon treatment, and/or atreatment anomaly optionally generates and or provides a recommendedtreatment change 1070. The treatment change 1070 is optionally sent outwhile the patient 730 is still in the treatment position, such as to aproximate physician or over the internet to a remote physician, forphysician approval 1072, receipt of which allows continuation of the nowmodified and approved treatment plan.

EXAMPLE I

Referring now to FIG. 7, a first example of the charged particle beamstate determination system 750 is illustrated using two cation inducedsignal generation surfaces, referred to herein as the first sheet 760and a third sheet 780. Each sheet is described below.

Still referring to FIG. 7, in the first example, the optional firstsheet 760, located in the charged particle beam path prior to thepatient 730, is coated with a first fluorophore coating 762, wherein acation, such as in the charged particle beam, transmitting through thefirst sheet 760 excites localized fluorophores of the first fluorophorecoating 762 with resultant emission of one or more photons. In thisexample, a first detector 812 images the first fluorophore coating 762and the main controller 110 determines a current position of the chargedparticle beam using the image of the fluorophore coating 762 and thedetected photon(s). The intensity of the detected photons emitted fromthe first fluorophore coating 762 is optionally used to determine theintensity of the charged particle beam used in treatment of the tumor720 or detected by the tomography system 700 in generation of a tomogramand/or tomographic image of the tumor 720 of the patient 730. Thus, afirst position and/or a first intensity of the charged particle beam isdetermined using the position and/or intensity of the emitted photons,respectively.

Still referring to FIG. 7, in the first example, the optional thirdsheet 780, positioned posterior to the patient 730, is optionally acation induced photon emitting sheet as described in the previousparagraph. However, as illustrated, the third sheet 780 is a solid statebeam detection surface, such as a detector array. For instance, thedetector array is optionally a charge coupled device, a charge induceddevice, CMOS, or camera detector where elements of the detector arrayare read directly, as does a commercial camera, without the secondaryemission of photons. Similar to the detection described for the firstsheet, the third sheet 780 is used to determine a position of thecharged particle beam and/or an intensity of the charged particle beamusing signal position and/or signal intensity from the detector array,respectively.

Still referring to FIG. 7, in the first example, signals from the firstsheet 760 and third sheet 780 yield a position before and after thepatient 730 allowing a more accurate determination of the chargedparticle beam through the patient 730 therebetween. Optionally,knowledge of the charged particle beam path in the targeting/deliverysystem 740, such as determined via a first magnetic field strengthacross the first axis control 142 or a second magnetic field strengthacross the second axis control 144 is combined with signal derived fromthe first sheet 760 to yield a first vector of the charged particlesprior to entering the patient 730 and/or an input point of the chargedparticle beam into the patient 730, which also aids in: (1) controlling,monitoring, and/or recording tumor treatment and/or (2) tomographydevelopment/interpretation. Optionally, signal derived from use of thethird sheet 780, posterior to the patient 730, is combined with signalderived from tomography system 700, such as the scintillation plate 710,to yield a second vector of the charged particles posterior to thepatient 730 and/or an output point of the charged particle beam from thepatient 730, which also aids in: (1) controlling, monitoring,deciphering, and/or (2) interpreting a tomogram or a tomographic image.

For clarity of presentation and without loss of generality, detection ofphotons emitted from sheets is used to further describe the chargedparticle beam state determination system 750. However, any of the cationinduced photon emission sheets described herein are alternativelydetector arrays. Further, any number of cation induced photon emissionsheets are used prior to the patient 730 and/or posterior to the patient730, such a 1, 2, 3, 4, 6, 8, 10, or more. Still further, any of thecation induced photon emission sheets are place anywhere in the chargedparticle beam, such as in the synchrotron 130, in the beam transportsystem 135, in the targeting/delivery system 140, the nozzle 146, in thegantry room, and/or in the tomography system 700. Any of the cationinduced photon emission sheets are used in generation of a beam statesignal as a function of time, which is optionally recorded, such as foran accurate history of treatment of the tumor 720 of the patient 730and/or for aiding generation of a tomographic image.

EXAMPLE II

Referring now to FIG. 8, a second example of the charged particle beamstate determination system 750 is illustrated using three cation inducedsignal generation surfaces, referred to herein as the second sheet 770,the third sheet 780, and the fourth sheet 790. Any of the second sheet770, the third sheet 780, and the fourth sheet 790 contain any of thefeatures of the sheets described supra.

Still referring to FIG. 8, in the second example, the second sheet 770,positioned prior to the patient 730, is optionally integrated into thenozzle 146, but is illustrated as a separate sheet. Signal derived fromthe second sheet 770, such as at point A, is optionally combined withsignal from the first sheet 760 and/or state of the targeting/deliverysystem 140 to yield a first vector, v_(1a), from point A to point B ofthe charged particle beam prior to the sample or patient 730 at a firsttime, t₁, and a second vector, v_(2a), from point F to point G of thecharged particle beam prior to the sample at a second time, t₂.

Still referring to FIG. 8, in the second example, the third sheet 780and the fourth sheet 790, positioned posterior to the patient 730, areoptionally integrated into the tomography system 700, but areillustrated as a separate sheets. Signal derived from the third sheet780, such as at point D, is optionally combined with signal from thefourth sheet 790 and/or signal from the tomography system 700 to yield afirst vector, v_(1b), from point C₂ to point D and/or from point D topoint E of the charged particle beam posterior to the patient 730 at thefirst time, t₁, and a second vector, v_(2a), such as from point H topoint I of the charged particle beam posterior to the sample at a secondtime, t₂. Signal derived from the third sheet 780 and/or from the fourthsheet 790 and the corresponding first vector at the second time, t₂, isused to determine an output point, C₂, which may and often does differfrom an extension of the first vector, v_(1a), from point A to point Bthrough the patient to a non-scattered beam path of point C₁. Thedifference between point C₁ and point C₂ and/or an angle, a, between thefirst vector at the first time, v_(1a), and the first vector at thesecond time, v_(1b), is used to determine/map/identify, such as viatomographic analysis, internal structure of the patient 730, sample,and/or the tumor 720, especially when combined with scanning the chargedparticle beam in the x/y-plane as a function of time, such asillustrated by the second vector at the first time, v_(2a), and thesecond vector at the second time, v_(2b), forming angle β and/or withrotation of the patient 730, such as about the y-axis, as a function oftime.

Still referring to FIG. 8, multiple detectors/detector arrays areillustrated for detection of signals from multiple sheets, respectively.However, a single detector/detector array is optionally used to detectsignals from multiple sheets, as further described infra. Asillustrated, a set of detectors 810 is illustrated, including a seconddetector 814 imaging the second sheet 770, a third detector 816 imagingthe third sheet 780, and a fourth detector 818 imaging the fourth sheet790. Any of the detectors described herein are optionally detectorarrays, are optionally coupled with any optical filter, and/oroptionally use one or more intervening optics to image any of the foursheets 760, 770, 780, 790. Further, two or more detectors optionallyimage a single sheet, such as a region of the sheet, to aid opticalcoupling, such as F-number optical coupling.

Still referring to FIG. 8, a vector of the charged particle beam isdetermined. Particularly, in the illustrated example, the third detector816, determines, via detection of secondary emitted photons, that thecharged particle beam transmitted through point D and the fourthdetector 818 determines that the charged particle beam transmittedthrough point E, where points D and E are used to determine the firstvector at the second time, v_(1b), as described supra. To increaseaccuracy and precision of a determined vector of the charged particlebeam, a first determined beam position and a second determined beamposition are optionally and preferably separated by a distance, d₁, suchas greater than 0.1, 0.5, 1, 2, 3, 5, 10, or more centimeters. A supportelement 752 is illustrated that optionally connects any two or moreelements of the charged particle beam state determination system 750 toeach other and/or to any element of the charged particle beam system100, such as a rotating platform 756 used to co-rotate the patient 730and any element of the tomography system 700.

EXAMPLE III

Still referring to FIG. 9A, a third example of the charged particle beamstate determination system 750 is illustrated in an integratedtomography-cancer therapy system 900.

Referring to FIG. 9A, multiple sheets and multiple detectors areillustrated determining a charged particle beam state prior to thepatient 730. As illustrated, a first camera 812 spatially images photonsemitted from the first sheet 760 at point A, resultant from energytransfer from the passing charged particle beam, to yield a first signaland a second camera 814 spatially images photons emitted from the secondsheet 770 at point B, resultant from energy transfer from the passingcharged particle beam, to yield a second signal. The first and secondsignals allow calculation of the first vector, v_(1a), with a subsequentdetermination of an entry point 732 of the charged particle beam intothe patient 730. Determination of the first vector, v_(1a), isoptionally supplemented with information derived from states of themagnetic fields about the first axis control 142, the vertical control,and the second axis control 144, the horizontal axis control, asdescribed supra.

Still referring to FIG. 9A, the charged particle beam statedetermination system is illustrated with multiple resolvable wavelengthsof light emitted as a result of the charged particle beam transmittingthrough more than one molecule type, light emission center, and/orfluorophore type. For clarity of presentation and without loss ofgenerality a first fluorophore in the third sheet 780 is illustrated asemitting blue light, b, and a second fluorophore in the fourth sheet 790is illustrated as emitting red light, r, that are both detected by thethird detector 816. The third detector is optionally coupled with anywavelength separation device, such as an optical filter, grating, orFourier transform device. For clarity of presentation, the system isdescribed with the red light passing through a red transmission filterblocking blue light and the blue light passing through a bluetransmission filter blocking red light. Wavelength separation, using anymeans, allows one detector to detect a position of the charged particlebeam resultant in a first secondary emission at a first wavelength, suchas at point C, and a second secondary emission at a second wavelength,such as at point D. By extension, with appropriate optics, one camera isoptionally used to image multiple sheets and/or sheets both prior to andposterior to the sample. Spatial determination of origin of the redlight and the blue light allow calculation of the first vector at thesecond time, v_(1b), and an actual exit point 736 from the patient 730as compared to a non-scattered exit point 734 from the patient 730 asdetermined from the first vector at the first time, v_(1a).

Still referring to FIG. 9A and referring now to FIG. 9B, the integratedtomography-cancer therapy system 900 is illustrated with an optionalconfiguration of elements of the charged particle beam statedetermination system 750 being co-rotatable with the nozzle 146 of thecancer therapy system 100. More particularly, in one case sheets of thecharged particle beam state determination system 750 positioned priorto, posterior to, or on both sides of the patient 730 co-rotate with thescintillation plate 710 about any axis, such as illustrated withrotation about the y-axis. In various cases, co-rotation is achieved byco-rotation of the gantry of the charged particle beam system and asupport of the patient, such as the rotatable platform 756, which isalso referred to herein as a movable or dynamically positionable patientplatform, patient chair, or patient couch. Mechanical elements, such asthe support element 752 affix the various elements of the chargedparticle beam state determination system 750 relative to each other,relative to the nozzle 146, and/or relative to the patient 730. Forexample, the support elements 752 maintain a second distance, d₂,between a position of the tumor 720 and the third sheet 780 and/ormaintain a third distance, d₃, between a position of the third sheet 780and the scintillation plate 710. More generally, support elements 752optionally dynamically position any element about the patient 730relative to one another or in x,y,z-space in a patientdiagnostic/treatment room, such as via computer control.

Referring now to FIG. 9B, positioning the nozzle 146 of a gantry 960 onan opposite side of the patient 730 from a detection surface, such asthe scintillation plate 710, in a gantry movement system 950 isdescribed. Generally, in the gantry movement system 950, as the gantry960 rotates about an axis the nozzle 146 and/or one or more magnets ofthe beam transport system 135 are repositioned. As illustrated, thenozzle 146 is positioned by the gantry 960 in a first position at afirst time, t₁, and in a second position at a second time, t₂, where npositions are optionally possible. An electromechanical system 712, suchas a patient table, patient couch, patient couch, and/or a scintillationplate holder maintains the patient 730 between the nozzle 146 and thescintillation plate 710 of the tomography system 700. Similarly, notillustrated for clarity of presentation, the electromechanical system712 maintains a position of the third sheet 780 and/or a position of thefourth sheet 790 on a posterior or opposite side of the patient 730 fromthe nozzle 146 as the gantry 960 rotates or moves the nozzle 146.Similarly, the electromechanical system 712 maintains a position of thefirst sheet 760 or first screen and/or a position of the second sheet770 or second screen on a same or prior side of the patient 730 from thenozzle 146 as the gantry 960 rotates or moves the nozzle 146. Asillustrated, the electromechanical system 712 optionally positions thefirst sheet 760 in the positively charged particle path at the firsttime, t₁, and rotates, pivots, and/or slides the first sheet 760 out ofthe positively charged particle path at the second time, t₂. Theelectromechanical system 712 is optionally and preferably connected tothe main controller 110 and/or the treatment delivery control system112. The electromechanical system 712 optionally maintains a fixeddistance between: (1) the patient and the nozzle 146 or the nozzle end612, (2) the patient 730 or tumor 720 and the scintillation plate 710,and/or (3) the nozzle 146 and the scintillation plate 710 at a firsttreatment time with the gantry 960 in a first position and at a secondtreatment time with the gantry 960 in a second position. Use of a commoncharged particle beam path for both imaging and cancer treatment and/ormaintaining known or fixed distances between beam transport/guideelements and treatment and/or detection surface enhances precisionand/or accuracy of a resultant image and/or tumor treatment, such asdescribed supra.

System Integration

Any of the systems and/or elements described herein are optionallyintegrated together and/or are optionally integrated with known systems.

Treatment Delivery Control System

Referring now to FIG. 10, a centralized charged particle treatmentsystem 1000 is illustrated. Generally, once a charged particle therapyplan is devised, a central control system or treatment delivery controlsystem 112 is used to control sub-systems while reducing and/oreliminating direct communication between major subsystems. Generally,the treatment delivery control system 112 is used to directly controlmultiple subsystems of the cancer therapy system without directcommunication between selected subsystems, which enhances safety,simplifies quality assurance and quality control, and facilitatesprogramming. For example, the treatment delivery control system 112directly controls one or more of: an imaging system, a positioningsystem, an injection system, a radio-frequency quadrupole system, alinear accelerator, a ring accelerator or synchrotron, an extractionsystem, a beam line, an irradiation nozzle, a gantry, a display system,a targeting system, and a verification system. Generally, the controlsystem integrates subsystems and/or integrates output of one or more ofthe above described cancer therapy system elements with inputs of one ormore of the above described cancer therapy system elements.

Still referring to FIG. 10, an example of the centralized chargedparticle treatment system 1000 is provided. Initially, a doctor, such asan oncologist, prescribes 1010 or recommends tumor therapy using chargedparticles. Subsequently, treatment planning 1020 is initiated and outputof the treatment planning step 1020 is sent to an oncology informationsystem 1030 and/or is directly sent to the treatment delivery system112, which is an example of the main controller 110.

Still referring to FIG. 10, the treatment planning step 1020 is furtherdescribed. Generally, radiation treatment planning is a process where ateam of oncologist, radiation therapists, medical physicists, and/ormedical dosimetrists plan appropriate charged particle treatment of acancer in a patient. Typically, one or more imaging systems 170 are usedto image the tumor and/or the patient, described infra. Planning isoptionally: (1) forward planning and/or (2) inverse planning. Cancertherapy plans are optionally assessed with the aid of a dose-volumehistogram, which allows the clinician to evaluate the uniformity of thedose to the tumor and surrounding healthy structures. Typically,treatment planning is almost entirely computer based using patientcomputed tomography data sets using multimodality image matching, imagecoregistration, or fusion.

Forward Planning

In forward planning, a treatment oncologist places beams into aradiotherapy treatment planning system including: how many radiationbeams to use and which angles to deliver each of the beams from. Thistype of planning is used for relatively simple cases where the tumor hasa simple shape and is not near any critical organs.

Inverse Planning

In inverse planning, a radiation oncologist defines a patient's criticalorgans and tumor and gives target doses and importance factors for each.Subsequently, an optimization program is run to find the treatment planwhich best matches all of the input criteria.

Oncology Information System

Still referring to FIG. 10, the oncology information system 1030 isfurther described. Generally, the oncology information system 1030 isone or more of: (1) an oncology-specific electronic medical record,which manages clinical, financial, and administrative processes inmedical, radiation, and surgical oncology departments; (2) acomprehensive information and image management system; and (3) acomplete patient information management system that centralizes patientdata; and (4) a treatment plan provided to the charged particle beamsystem 100, main controller 110, and/or the treatment delivery controlsystem 112. Generally, the oncology information system 1030 interfaceswith commercial charged particle treatment systems.

Safety System/Treatment Delivery Control System

Still referring to FIG. 10, the treatment delivery control system 112 isfurther described. Generally, the treatment delivery control system 112receives treatment input, such as a charged particle cancer treatmentplan from the treatment planning step 1020 and/or from the oncologyinformation system 1030 and uses the treatment input and/or treatmentplan to control one or more subsystems of the charged particle beamsystem 100. The treatment delivery control system 112 is an example ofthe main controller 110, where the treatment delivery control systemreceives subsystem input from a first subsystem of the charged particlebeam system 100 and provides to a second subsystem of the chargedparticle beam system 100: (1) the received subsystem input directly, (2)a processed version of the received subsystem input, and/or (3) acommand, such as used to fulfill requisites of the treatment planningstep 1020 or direction of the oncology information system 1030.Generally, most or all of the communication between subsystems of thecharged particle beam system 100 go to and from the treatment deliverycontrol system 112 and not directly to another subsystem of the chargedparticle beam system 100. Use of a logically centralized treatmentdelivery control system has many benefits, including: (1) a singlecentralized code to maintain, debug, secure, update, and to performchecks on, such as quality assurance and quality control checks; (2) acontrolled logical flow of information between subsystems; (3) anability to replace a subsystem with only one interfacing code revision;(4) room security; (5) software access control; (6) a single centralizedcontrol for safety monitoring; and (7) that the centralized code resultsin an integrated safety system 1040 encompassing a majority or all ofthe subsystems of the charged particle beam system 100. Examples ofsubsystems of the charged particle cancer therapy system 100 include: aradio frequency quadrupole 1050, a radio frequency quadrupole linearaccelerator, the injection system 120, the synchrotron 130, theaccelerator system 132, the extraction system 134, any controllable ormonitorable element of the beam line 268, the targeting/delivery system140, the nozzle 146, a gantry 1060 or an element of the gantry 1060, thepatient interface module 150, a patient positioner 152, the displaysystem 160, the imaging system 170, a patient position verificationsystem 172, any element described supra, and/or any subsystem element. Atreatment change 1070 at time of treatment is optionally computergenerated with or without the aid of a technician or physician andapproved while the patient is still in the treatment room, in thetreatment chair, and/or in a treatment position.

Safety

Referring now to FIG. 11, a redundant safety system 1100 is described.In one optional and preferred embodiment, the charged particle beamsystem 100 includes redundant systems for determination of one or moreof: (1) beam position, (2) beam direction, (3) beam intensity, (4) beamenergy, and (5) beam shape. The redundant safety system 1000 is furtherdescribed herein.

Beam Position

A beam positioning system 1110 or beam positiondetermination/verification system is linked to the main controller 100or treatment delivery control system 112. The beam positioning system1110 includes any electromechanical system, optical system, and/orcalculation for determining a current position of the charged particlebeam. In a first case, after calibration, thescanning/targeting/delivery system 140 uses x/y-positioning magnets,such as in the first axis control 142 and the second axis control 144,to position the charged particle beam. In a second case, a photonicemission position system 1114 is used to measure a position of thecharged particle beam, where the photonic emission system 1114 uses asecondary emission of a photon upon passage of the charged particlebeam, such as described supra for the first sheet 760, the second sheet770, the third sheet 780, and the fourth sheet 790. In a third a case, ascintillation positioning system 1116, such as via use of a detectorelement in the tomography system 700, is used to measure a position ofthe charged particle beam. Any permutation or combination of the threecases described herein yield multiple or redundant measures of thecharged particle beam position and therefrom one or more measures of acharged particle beam vector during a period of time.

Beam Intensity

A beam intensity system 1120 or beam intensitydetermination/verification system is linked to the main controller 100or treatment delivery control system 112. Herein, intensity is a numberof positively charged particles passing a point or plane as a functionof time. The beam intensity system 1110 includes any electromechanicalsystem, optical system, and/or calculation for determining a currentintensity of the charged particle beam. In a first case, the extractionsystem 134 uses an electron emission system 1122, such as a secondaryemission of electrons upon passage of the charged particle beam throughthe extraction material 330, to determine an intensity of the chargedparticle beam. In a second case, the duration of the applied RF-fieldand/or a magnitude of the RF-field applied in the RF-cavity system 310is used to calculate the intensity of the charged particle beam, asdescribed supra. In a third case, a photon emission system 1124, such asa magnitude of a signal representing the emitted photons from thephotonic emission system 1114, is used to measure the intensity of thecharged particle beam. In a fourth case, a scintillation intensitydetermination system 1126 measures the intensity of the charged particlebeam, such as with a detector of the tomography system 700.

Beam Energy

A beam energy system 1130 or beam energy determination/verificationsystem is linked to the main controller 100 or treatment deliverycontrol system 112. Herein, energy is optionally referred to as avelocity of the positively charged particles passing a point, whereenergy is dependent upon mass of the charged particles. The beam energysystem 1110 includes any electromechanical system, optical system,and/or calculation for determining a current energy of the chargedparticle beam. In a first case, an RF-cavity energy system 1132calculates an energy of the charged particles in the charged particlebeam, such as via relating a period of an applied RF-field in theRF-cavity system 310 to energy, such as described supra. In a secondcase, an in-line energy system 1134 is used to measure a value relatedto beam energy, such as described above in equations 1 and 2. In a thirdcase, a scintillation energy system 1136 is used to measure an energy ofthe charged particle beam, such as via use of a detector in thetomography system 700.

Optionally and preferably, two or moremeasures/determination/calculations of a beam state property, such asposition, direction, shape, intensity, and/or energy yield a redundantmeasure of the measured state for use in a beam safety system and/or anemergency beam shut-off system. Optionally and preferably, the two ormore measures of a beam state property are used to enhance precisionand/or accuracy of determination of the beam state property throughstatistical means. Optionally and preferably, any of the beam stateproperties are recorded and/or used to predict a future state, such asposition, intensity, and/or energy of the charged particle beam, such asin a neighboring voxel in the tumor 720 adjacent to a currently treatedvoxel in the tumor 720 of the patient 730.

Motion Control System

Referring now to FIG. 12A, a motion control system 1200 is illustrated.Generally, the motion control system controls, as a function of time:(1) the charged particle beam state, such as direction, shape,intensity, and/or energy; (2) a patient position; and/or (3) an imagingsystem. The motion control system 1200 is further described herein.

The motion control system 1200 optionally uses one or more patientinterface controllers 1210, such as an external motion control system1212, an internal motion control system 1214, an external pendant 1216,and an internal pendant 1218. As illustrated, the patient 730 is in atreatment room 1222 separated from a control room 1224 by a radiationshielded wall 1226 and a window 1228 or view port. The external motioncontrol system 1212, internal motion control system 1214, externalpendant 1216, and the internal pendant 1218 optionally and preferablycontrol the same elements, allowing one or more operators control of themotion control system. Any of the patient interface controllers 1210 areoptionally linked to each other or to the main controller 110 viawireless means; however, interconnections of the patient interfacecontrollers 1210 to each other and/or to the main controller 110 arepreferably hard-wired due to high radiation levels in the treatment room1222. For example, the external pendant 1216 is linked via a firstcommunication bundle 1217 to the external motion control system 1212,the internal pendant 1218 is linked via a second communication bundle1219 to the internal motion system controller 1214, and/or the internaland external motion control system 1212, 1214 are hardwired to eachother and/or to the main controller 110. The first communication bundle1217 and the second communication bundle 1219 optionally provide powerto the external pendant 1216 and the internal pendant 1218,respectively. The second communication bundle 1219 is optionallyattached and/or linked to the nozzle system 146 and/or an element of thebeam transport system 135 to keep the second communication bundle: (1)accessible to the operator, (2) out of the way of the charged particlebeam, and/or (3) out of the way of motion of the patient 730/patientinterface module 150. Optionally, a patient specific treatment module1290 is replaceably plugged into and/or attached to the one or morepatient interface controllers 1210, such as the internal pendant 1218.The patient treatment module 1290 optionally contains one or more of:image information about the individual being treated and/orpreprogrammed treatment steps for the individual being treated, wheresome controls of the charged particle beam system 100, such as relatedto charged particle beam aiming and/or patient positioning areoptionally limited by the preprogrammed treatment steps of anyinformation/hardware of the patient treatment module. Optionally, theinternal pendant 1218 replaceably mounts to a bracket, hook, slot, orthe like mounted on the nozzle system 146 or the beam transport system135 to maintain close access for the operator when not in use. Theoperator optionally and preferably uses, at times, a mobile controlpendant, such as the external pendant 1216 or the internal pendant 1218.The operator optionally has access via a direct doorway 1229 betweentreatment room 1222 and the control room 1224. Use of multiple patientinterface controllers 1210 gives flexibility to an operator of themotion control system 1200, as further described infra.

EXAMPLE I

In a first example, the operator of the motion control system 1200 isoptionally seated or standing by a fixed position controller, such as bya desktop or wall mounted version of the external motion control system1212. Similarly, the internal motion control system 1214 is optionallyand preferably in a fixed position, such as at a desktop system or wallmounted system.

EXAMPLE II

In a second example, the operator optionally and preferably uses, attimes, the external pendant 1216, which allows the operator to view thepatient 730, the beam transport system 135, the patient interface module150, and/or the imaging system 170 through the safety of the window1228. Optionally and preferably, the beam transport system 135 isconfigured with one or more mechanical stops to not allow the chargedparticle beam to aim at the window 1228, thereby providing acontinuously safe zone for the operator. Direct viewing and control ofthe charged particle beam system 100, imaging system 170, and/ortomography system 700 relative to the current position of the patient730 allows backup security in terms of unexpected aim of a treatmentbeam and/or movement of the patient 730. Controlled elements and/orprocesses of the charged particle beam system 100 via the pendants isfurther described, infra.

EXAMPLE III

In a third example, the operator optionally and preferably uses, attimes, the internal pendant 1218, which allows the operator both directaccess and view of: (1) the patient 730, (2) the beam transport system135, (3) the patient interface module 150, and/or (4) the imaging system170, which has multiple benefits. In a first case, the operator canadjust any element of the patient interface module 150, such as apatient positioning device and/or patient motion constraint device. In asecond case, the operator has access to load/unload: (1) the patientspecific tray insert 510 into the beam control tray assembly 400; (2)the beam control tray assembly 400 into the nozzle system 146, asdescribed supra; and/or (3) any imaging material, such as an X-ray film.

EXAMPLE IV

In a fourth example, the gantry comprises at least two imaging devices,where each imaging device moves with rotation of the gantry and wherethe two imaging devices view the patient 730 along two axes forming anangle of ninety degrees, in the range of eighty-five to ninety-fivedegrees, and/or in the range of seventy-five to one hundred fivedegrees.

Pendant

Referring still to FIG. 12A and referring now to FIG. 12B, a pendantsystem 1250, such as a system using the external pendant 1216 and/orinternal pendent 1218 is described. In a first case, the externalpendant 1216 and internal pendant 1218 have identical controls. In asecond case, controls and/or functions of the external pendant 1216intersect with controls and/or function of the internal pendant 1218.Particular processes and functions of the internal pendant 1218 areprovided below, without loss of generality, to facilitate description ofthe external and internal pendants 1216, 1218. The internal pendant 1218optionally comprises any number of input buttons, screens, tabs,switches, or the like. The pendant system 1250 is further described,infra.

EXAMPLE I

Referring now to FIG. 12B, a first example of the internal pendant 1218is provided. In this example, in place of and/or in conjunction with aparticular button, such as a first button 1270 and/or a second button1280, moving or selecting a particular element, processes are optionallydescribed, displayed, and/or selected within a flow process control unit1260 of the internal pendant 1218. For example, one or more displayscreens and/or printed elements describe a set of processes, such as afirst process 1261, a second process 1263, a third process 1265, and afourth process 1267 and are selected through a touch screen selectionprocess or via a selection button, such as a corresponding firstselector 1262, second selector 1264, third selector 1266, and fourthselector 1268. Optionally, a next button a-priori or previouslyscheduled in treatment planning to select a next process is lit up onthe pendant.

EXAMPLE II

Referring still to FIG. 12B, a second example of the internal pendant1218 is provided. In this example, one or more buttons or the like, suchas the first button 1270, and/or one or more of the processes, such asthe first process 1261, are customizable, such as to an often repeatedset of steps and/or to steps particular to treatment of a given patient730. The customizable element, such as the first button 1270, isoptionally further setup, programmed, controlled, and/or limited viainformation received from the patient treatment module 1290. In thisexample, a button, or the like, operates as an emergency all stopbutton, which at the minimum shuts down the accelerator, redirects thecharged particle beam to a beam stop separate from a path through thepatient, or stops moving the patient 730.

EXAMPLE III

In place of and/or in conjunction with a particular button, such as thefirst button 1270 and/or the second button 1280, moving or selecting aparticular element, processes are optionally described, displayed,and/or selected within a flow process control unit 1260 of the internalpendant 1218. For example, one or more display screens and/or printedelements describe a set of processes, such as a first process 1261, asecond process 1263, a third process 1265, and a fourth process 1267 andare selected through a touch screen selection process or via a selectionbutton, such as a corresponding first selector 1262, second selector1264, third selector 1266, and fourth selector 1268.

Referring still to FIG. 12B, as illustrated for clarity and without lossor generalization, the first process 1261 and/or a display screenthereof operable by the first selector 1262 selects, initiates, and/orprocesses a set of steps related to the beam control tray assembly 400.For instance, the first selector 1262, functioning as a tray button: (1)confirms presence a requested patient specific tray insert 510 in arequested tray assembly; (2) confirms presence of a request patientspecific tray insert in a receiving slot of the control tray assembly;(3) retracts the beam control tray assembly 400 into the nozzle system146; (4) confirms information using the electromechanical identifierplug, such as the first electromechanical identifier plug 530; (5)confirms information using the patient treatment module 1290; and/or (6)performs a set of commands and/or movements identified with the firstselector 1262 and/or identified with the first process 1261. Similarly,the second process 1263, corresponding to a second process displayscreen and/or the second selector 1264; the third process 1265,corresponding to a third process display screen and/or the thirdselector 1266; and the fourth process 1267, corresponding to a fourthprocess display screen and/or the fourth selector 1268 control and/oractivate a set of actions, movements, and/or commands related topositioning the patient 730, imaging the patient 730, and treating thepatient 730, respectively.

Integrated Cancer Treatment—Imaging System

One or more imaging systems 170 are optionally used in a fixed positionin a cancer treatment room and/or are moved with a gantry system, suchas a gantry system supporting: a portion of the beam transport system135, the targeting/delivery control system 140, and/or moving orrotating around a patient positioning system, such as in the patientinterface module. Without loss of generality and to facilitatedescription of the invention, examples follow of an integrated cancertreatment—imaging system. In each system, the beam transport system 135and/or the nozzle system 146 indicates a positively charged beam path,such as from the synchrotron, for tumor treatment and/or for tomography,as described supra.

EXAMPLE I

Referring now to FIG. 13A, a first example of an integrated cancertreatment—imaging system 1300 is illustrated. In this example, thecharged particle beam system 100 is illustrated with a treatment beam269 directed to the tumor 720 of the patient 730 along the z-axis. Alsoillustrated is a set of imaging sources 1310, imaging system elements,and/or paths therefrom and a set of detectors 1320 corresponding to arespective element of the set of imaging sources 1310. Herein, the setof imaging sources 1310 are referred to as sources, but are optionallyany point or element of the beam train prior to the tumor or a centerpoint about which the gantry rotates. Hence, a given imaging source isoptionally a dispersion element used to for cone beam. As illustrated, afirst imaging source 1312 yields a first beam path 1332 and a secondimaging source 1314 yields a second beam path 1334, where each pathpasses at least into the tumor 720 and optionally and preferably to afirst detector array 1322 and a second detector array 1324,respectively, of the set of detectors 1320. Herein, the first beam path1332 and the second beam path 1334 are illustrated as forming a ninetydegree angle, which yields complementary images of the tumor 720 and/orthe patient 730. However, the formed angle is optionally any angle fromten to three hundred fifty degrees. Herein, for clarity of presentation,the first beam path 1332 and the second beam path 1334 are illustratedas single lines, which optionally is an expanding, uniform diameter, orfocusing beam. Herein, the first beam path 1332 and the second beam path1334 are illustrated in transmission mode with their respective sourcesand detectors on opposite sides of the patient 730. However, a beam pathfrom a source to a detector is optionally a scattered path and/or adiffuse reflectance path. Optionally, one or more detectors of the setof detectors 1320 are a single detector element, a line of detectorelements, or preferably a two-dimensional detector array. Use of twotwo-dimensional detector arrays is referred to herein as atwo-dimensional—two-dimensional imaging system or a 2D-2D imagingsystem.

Still referring to FIG. 13A, the first imaging source 1312 and thesecond imaging source 1314 are illustrated at a first position and asecond position, respectively. Each of the first imaging source 1312 andthe second imaging source 1322 optionally: (1) maintain a fixedposition; (2) provide the first beam path 1332 and the second beam path1334, respectively, through the gantry 960, such as through a set of oneor more holes or slits; (3) provide the first beam path 1332 and thesecond beam path 1334, respectively, off axis to a plane of movement ofthe nozzle system 760; (4) move with the gantry 960 as the gantry 960rotates about at least a first axis; and/or (5) represent a narrowcross-diameter section of an expanding cone beam path.

Still referring to FIG. 13A, the set of detectors 1320 are illustratedas coupling with respective elements of the set of sources 1310. Eachmember of the set of detectors 1320 optionally and preferablyco-moves/and/or co-rotates with a respective member of the set ofsources 1310. Thus, if the first imaging source 1312 is staticallypositioned, then the first detector 1322 is optionally and preferablystatically positioned. Similarly, to facilitate imaging, if the firstimaging source 1312 moves along a first arc as the gantry 960 moves,then the first detector 1322 optionally and preferably moves along thefirst arc or a second arc as the gantry 960 moves, where relativepositions of the first imaging source 1312 on the first arc, a pointthat the gantry 960 moves about, and relative positions of the firstdetector 1322 along the second arc are constant. To facilitate theprocess, the detectors are optionally mechanically linked, such as witha first mechanical support 1342 to the gantry 960 in a manner that whenthe gantry 960 moves, the gantry moves both the source and thecorresponding detector. Optionally, the source moves and a series ofdetectors, such as along the second arc, capture a set of images.

Still referring to FIG. 13A, optionally and preferably, elements of theset of sources 1310 combined with elements of the set of detectors 1320are used to collect a series of responses, such as one source and onedetector yielding a detected intensity and preferably a set of detectedintensities to form an image. For instance, the first imaging source1312, such as a first X-ray source or first cone beam X-ray source, andthe first detector 1322, such as an X-ray film, digital X-ray detector,or two-dimensional detector, yield a first X-ray image of the patient ata first time and a second X-ray image of the patient at a second time,such as to confirm a maintained location of a tumor or after movement ofthe gantry 760 or rotation of the patient 730. A set of n images usingthe first imaging source 1312 and the first detector 1322 collected as afunction of movement of the gantry 760 and/or as a function of movementand/or rotation of the patient 730 are optionally and preferablycombined to yield a three-dimensional image of the patient 730, such asa three-dimensional X-ray image of the patient 730, where n is apositive integer, such as greater than 1, 2, 3, 4, 5, 10, 15, 25, 50, or100. The set of n images is optionally gathered as described incombination with images gathered using the second imaging source 1314,such as a second X-ray source or second cone beam X-ray source, and thesecond detector 1324, such as a second X-ray detector, where the use oftwo, or multiple, source/detector combinations are combined to yieldimages where the patient 730 has not moved between images as the two, orthe multiple, images are optionally and preferably collected at the sametime, such as with a difference in time of less than 0.01, 0.1, 1, or 5seconds. Longer time differences are optionally used. Preferably the ntwo-dimensional images are collected as a function of rotation of thegantry 960 about the tumor and/or the patient and/or as a function ofrotation of the patient 730 and the two-dimensional images of the X-raycone beam are mathematically combined to form a three-dimensional imageof the tumor 720 and/or the patient 730. Optionally, the first X-raysource and/or the second X-ray source is the source of X-rays that aredivergent forming a cone through the tumor. A set of images collected asa function of rotation of the divergent X-ray cone around the tumor witha two-dimensional detector that detects the divergent X-rays transmittedthrough the tumor is used to form a three-dimensional X-ray of the tumorand of a portion of the patient, such as in X-ray computed tomography.

Still referring to FIG. 13A, use of two imaging sources and twodetectors set at ninety degrees to one another allows the gantry 960 orthe patient 730 to rotate through half an angle required using only oneimaging source and detector combination. A third imaging source/detectorcombination allows the three imaging source/detector combination to beset at sixty degree intervals allowing the imaging time to be cut tothat of one-third that gantry 960 or patient 730 rotation required usinga single imaging source-detector combination. Generally, nsource-detector combinations reduces the time and/or the rotationrequirements to 1/n. Further reduction is possible if the patient 730and the gantry 960 rotate in opposite directions. Generally, the used ofmultiple source-detector combination of a given technology allow for agantry that need not rotate through as large of an angle, with dramaticengineering benefits.

Still referring to FIG. 13A, the set of sources 1310 and set ofdetectors 1320 optionally use more than one imaging technology. Forexample, a first imaging technology uses X-rays, a second usedfluoroscopy, a third detects fluorescence, a fourth uses cone beamcomputed tomography or cone beam CT, and a fifth uses otherelectromagnetic waves. Optionally, the set of sources 1310 and the setof detectors 1320 use two or more sources and/or two or more detectorsof a given imaging technology, such as described supra with two X-raysources to n X-ray sources.

Still referring to FIG. 13A, use of one or more of the set of sources1310 and use of one or more of the set of detectors 1320 is optionallycoupled with use of the positively charged particle tomography systemdescribed supra. As illustrated in FIG. 13A, the positively chargedparticle tomography system uses a second mechanical support 1343 toco-rotate the scintillation plate 710 with the gantry 960, as well as toco-rotate an optional sheet, such as the first sheet 760 and/or thefourth sheet 790.

EXAMPLE II

Referring now to FIG. 13B, a second example of the integrated cancertreatment—imaging system 1300 is illustrated using greater than threeimagers.

Still referring to FIG. 13B, two pairs of imaging systems areillustrated. Particularly, the first and second imaging source 1312,1314 coupled to the first and second detectors 1322, 1324 are asdescribed supra. For clarity of presentation and without loss ofgenerality, the first and second imaging systems are referred to as afirst X-ray imaging system and a second X-ray imaging system. The secondpair of imaging systems uses a third imaging source 1316 coupled to athird detector 1326 and a fourth imaging source 1318 coupled to a fourthdetector 1328 in a manner similar to the first and second imagingsystems described in the previous example. Here, the second pair ofimaging systems optionally and preferably uses a second imagingtechnology, such as fluoroscopy. Optionally, the second pair of imagingsystems is a single unit, such as the third imaging source 1318 coupleto the third detector 1328, and not a pair of units. Optionally, one ormore of the set of imaging sources 1310 are statically positioned whileone of more of the set of imaging sources 1310 co-rotate with the gantry960. Pairs of imaging sources/detector optionally have common anddistinct distances, such as a first distance, d₁, such as for a firstsource-detector pair and a second distance, d₂, such as for a secondsource-detector or second source-detector pair. As illustrated, thetomography detector or the scintillation plate 710 is at a thirddistance, d₃. The distinct differences allow the source-detectorelements to rotate on a separate rotation system at a rate differentfrom rotation of the gantry 960, which allows collection of a fullthree-dimensional image while tumor treatment is proceeding with thepositively charged particles.

EXAMPLE III

For clarity of presentation, referring now to FIG. 13C, any of the beamsor beam paths described herein is optionally a cone beam 1390 asillustrated. The patient support 152 is an mechanical and/orelectromechanical device used to position, rotate, and/or constrain anyportion of the tumor 720 and/or the patient 730 relative to any axis.

Still yet another embodiment includes any combination and/or permutationof any of the elements described herein.

Herein, any number, such as 1, 2, 3, 4, 5, is optionally more than thenumber, less than the number, or within 1, 2, 5, 10, 20, or 50 percentof the number.

The particular implementations shown and described are illustrative ofthe invention and its best mode and are not intended to otherwise limitthe scope of the present invention in any way. Indeed, for the sake ofbrevity, conventional manufacturing, connection, preparation, and otherfunctional aspects of the system may not be described in detail.Furthermore, the connecting lines shown in the various figures areintended to represent exemplary functional relationships and/or physicalcouplings between the various elements. Many alternative or additionalfunctional relationships or physical connections may be present in apractical system.

In the foregoing description, the invention has been described withreference to specific exemplary embodiments; however, it will beappreciated that various modifications and changes may be made withoutdeparting from the scope of the present invention as set forth herein.The description and figures are to be regarded in an illustrativemanner, rather than a restrictive one and all such modifications areintended to be included within the scope of the present invention.Accordingly, the scope of the invention should be determined by thegeneric embodiments described herein and their legal equivalents ratherthan by merely the specific examples described above. For example, thesteps recited in any method or process embodiment may be executed in anyorder and are not limited to the explicit order presented in thespecific examples. Additionally, the components and/or elements recitedin any apparatus embodiment may be assembled or otherwise operationallyconfigured in a variety of permutations to produce substantially thesame result as the present invention and are accordingly not limited tothe specific configuration recited in the specific examples.

Benefits, other advantages and solutions to problems have been describedabove with regard to particular embodiments; however, any benefit,advantage, solution to problems or any element that may cause anyparticular benefit, advantage or solution to occur or to become morepronounced are not to be construed as critical, required or essentialfeatures or components.

As used herein, the terms “comprises”, “comprising”, or any variationthereof, are intended to reference a non-exclusive inclusion, such thata process, method, article, composition or apparatus that comprises alist of elements does not include only those elements recited, but mayalso include other elements not expressly listed or inherent to suchprocess, method, article, composition or apparatus. Other combinationsand/or modifications of the above-described structures, arrangements,applications, proportions, elements, materials or components used in thepractice of the present invention, in addition to those not specificallyrecited, may be varied or otherwise particularly adapted to specificenvironments, manufacturing specifications, design parameters or otheroperating requirements without departing from the general principles ofthe same.

Although the invention has been described herein with reference tocertain preferred embodiments, one skilled in the art will readilyappreciate that other applications may be substituted for those setforth herein without departing from the spirit and scope of the presentinvention. Accordingly, the invention should only be limited by theClaims included below.

The invention claimed is:
 1. An apparatus for imaging a tumor of apatient with positively charged particles, comprising: a beam transportsystem configured to transport the positively charged particles from asynchrotron to at least the tumor of the patient along a treatment beampath; a first imaging system comprising a first imaging beam path from agantry to the tumor; and a second imaging system comprising a secondimaging beam path from said gantry to the tumor, said first imaging beampath, a rotation point about which the gantry rotates, and the secondimaging beam path forming an angle of greater than fifty degrees, saidgantry configured to physically support a set of elements comprising:(1) at least a portion of said beam transport system, (2) at least aportion of said first imaging system, and (3) at least a portion of saidsecond imaging system.
 2. The apparatus of claim 1, said first imagingsystem comprising a first X-ray imaging system, said second imagingsystem comprising a second X-ray system.
 3. The apparatus of claim 2,said gantry further comprising: an arc, said gantry configured toco-move said set of elements along said arc.
 4. The apparatus of claim3, said first X-ray imaging system comprising a first cone beam X-rayelement, said second X-ray imaging system comprising a second cone beamX-ray element.
 5. The apparatus of claim 4, said first X-ray imagingsystem and said second X-ray imaging system combining to form at leastone cone beam computed tomography X-ray system.
 6. The apparatus ofclaim 4, said first imaging system further comprising: a firsttwo-dimensional detection surface mounted opposite the rotation pointfrom a center of a connection point of said at least a portion of saidfirst imaging system to said gantry.
 7. The apparatus of claim 1, saidfirst imaging system comprising an element of a two-dimensional conebeam computed tomography X-ray system.
 8. The apparatus of claim 7, saidsecond imaging system comprising a fluoroscopy system.
 9. A method forimaging a tumor of a patient with positively charged particles,comprising the steps of: transporting the positively charged particles,using a beam transport system, from a synchrotron to at least the tumorof the patient along a treatment beam path; functioning a first imagingsystem along a first imaging beam path from a gantry to the tumor; andoperating a second imaging system along a second imaging beam path fromsaid gantry to the tumor, said first imaging beam path, the tumor, andsaid second imaging beam path forming an angle of greater than sixtydegrees, wherein said gantry physically supports a set of elementscomprising: (1) at least a portion of said beam transport system, (2) atleast a portion of said first imaging system, and (3) at least a portionof said second imaging system.
 10. The method of claim 9, furthercomprising the step of: rotating said gantry about a rotation point,said step of rotating further comprising the step of: moving said set ofelements along a first arc.
 11. The method of claim 10, furthercomprising the steps of: imaging the tumor using both said first imagingsystem and said second imaging system to form an image; and treating thetumor with the positively charged particles using the image.
 12. Themethod of claim 11, further comprising the step of: controlling bothsaid step of imaging and said step of treating with a portable controlpendant positioned in view of said gantry and outside of a treatmentroom housing said gantry.
 13. The method of claim 11, further comprisingthe step of: generating a tomographic image from a detected signalresultant from the positively charged particles after the positivelycharged particles transit through said tumor; and said step of treatingthe tumor further comprising the step of using the tomographic image intargeting the tumor.
 14. The method of claim 13, further comprising thesteps of: positioning a first light emitting material in a plane acrossthe treatment beam path between an exit nozzle of said beam transportsystem and the tumor; detecting photons emitted from said light emittingmaterial upon transmission of the positively charged particles throughsaid first light emitting material; and determining a path of thepositively charged particles using both the photons and said tomographicimage.
 15. The method of claim 9, said first imaging system furthercomprising a cone beam computed tomography X-ray based imaging system.16. The method of claim 15, further comprising the step of: co-rotating:(1) a first source element and a first detector of said first imagingsystem and (2) a second source element and a second detector of saidsecond imaging system.
 17. The method of claim 16, further comprisingthe step of: tomographically imaging the tumor to form a tomographicimage using the positively charged particles.
 18. The method of claim17, further comprising the step of: implementing a cancer treatmenttherapy plan using both a first image generated using said cone beamcomputed tomography X-ray based imaging system and said tomographicimage.
 19. The method of claim 18, further comprising the steps of: saidgantry physically supporting a third imaging system, said third imagingsystem not using X-rays or the positively charged particles; andgenerating a tumor image using said third imaging system.
 20. The methodof claim 9 further comprising the steps of: rotating the patient with apatient positioning system; generating a cone beam computed tomographyimage of the tumor without rotation of the gantry; and treating thetumor of the patient, using the cone beam computed tomography image,with the positively charged particles.